Provider Demographics
NPI:1326029570
Name:BLUM, ISAAC (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:BLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ISAAC
Other - Middle Name:G
Other - Last Name:BLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:64 GRIFFEN AVE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7613
Mailing Address - Country:US
Mailing Address - Phone:914-574-5977
Mailing Address - Fax:
Practice Address - Street 1:900 INTERVALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4240
Practice Address - Country:US
Practice Address - Phone:917-645-9200
Practice Address - Fax:718-589-7010
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111159207Q00000X, 208D00000X, 207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00696240Medicaid
NY656282Medicare ID - Type Unspecified
NY00696240Medicaid