Provider Demographics
NPI:1275554958
Name:YAAKOV-BLECHMAN, MIRALLE (MD)
Entity Type:Individual
Prefix:
First Name:MIRALLE
Middle Name:
Last Name:YAAKOV-BLECHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4201
Mailing Address - Country:US
Mailing Address - Phone:203-576-6133
Mailing Address - Fax:203-863-3821
Practice Address - Street 1:2800 MAIN STREET
Practice Address - Street 2:EMERGENCY DEPARTMENT SAINT VINCENT MEDICAL CENTER
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-576-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038554207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02354676Medicaid
CT930001138Medicare ID - Type Unspecified
NYA400000892Medicare PIN
NY02354676Medicaid