Provider Demographics
NPI:1235134941
Name:BLATSTEIN, R M (DPM PA)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:M
Last Name:BLATSTEIN
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-7229
Mailing Address - Country:US
Mailing Address - Phone:772-225-3668
Mailing Address - Fax:772-334-4115
Practice Address - Street 1:1635 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-7229
Practice Address - Country:US
Practice Address - Phone:772-225-3668
Practice Address - Fax:772-334-4115
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01563213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87879YMedicare PIN
1117670001Medicare NSC
FL87879Medicare PIN