Provider Demographics
NPI:1164651626
Name:GOLDBLATT, RICHARD BRIAN (PA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BRIAN
Last Name:GOLDBLATT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 LENOX ROAD, BOX 50
Mailing Address - Street 2:SUNY DOWNSTATE UNIVERSITY HOSPITAL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-270-1000
Mailing Address - Fax:
Practice Address - Street 1:445 LENOX ROAD
Practice Address - Street 2:SUNY DOWNSTATE UNIVERSITY HOSPITAL, BOX 50
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-270-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002200-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical