Provider Demographics
NPI:1164477477
Name:JOEL D. WEISBLAT, M.D., INC.
Entity Type:Organization
Organization Name:JOEL D. WEISBLAT, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WEISBLAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-464-4646
Mailing Address - Street 1:3619 PARK EAST DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4330
Mailing Address - Country:US
Mailing Address - Phone:216-464-4646
Mailing Address - Fax:216-464-4695
Practice Address - Street 1:3619 PARK EAST DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4330
Practice Address - Country:US
Practice Address - Phone:216-464-4646
Practice Address - Fax:216-464-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-064937261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJ09344831Medicare ID - Type Unspecified