Provider Demographics
NPI:1104835784
Name:KORNBLUTH, ARTHUR A (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:A
Last Name:KORNBLUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6828
Mailing Address - Country:US
Mailing Address - Phone:212-369-2490
Mailing Address - Fax:212-987-9676
Practice Address - Street 1:1751 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6828
Practice Address - Country:US
Practice Address - Phone:212-369-2490
Practice Address - Fax:212-987-9676
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165586207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63841Medicare UPIN
NYWCW641Medicare ID - Type Unspecified