Provider Demographics
NPI:1235333204
Name:NEIL BLATT
Entity Type:Organization
Organization Name:NEIL BLATT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-423-3535
Mailing Address - Street 1:2383 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2053
Mailing Address - Country:US
Mailing Address - Phone:718-423-3535
Mailing Address - Fax:
Practice Address - Street 1:2383 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2053
Practice Address - Country:US
Practice Address - Phone:718-423-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T32005Medicare UPIN
00469Medicare PIN