Provider Demographics
NPI:1154489284
Name:BLATTI, GEORGE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:BLATTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:363A HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1256
Mailing Address - Country:US
Mailing Address - Phone:516-599-5885
Mailing Address - Fax:800-557-3140
Practice Address - Street 1:363A HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1256
Practice Address - Country:US
Practice Address - Phone:516-599-5885
Practice Address - Fax:800-557-3140
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY126420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0075J1Medicare PIN
NYB11223Medicare UPIN