Provider Demographics
NPI:1326078320
Name:BLATT, KENNETH B (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:B
Last Name:BLATT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4000 ROUTE 66
Mailing Address - Street 2:SUITE 131
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7300
Mailing Address - Country:US
Mailing Address - Phone:732-383-4166
Mailing Address - Fax:732-383-4171
Practice Address - Street 1:2130 MILLBURN AVE
Practice Address - Street 2:SUITE A8
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3725
Practice Address - Country:US
Practice Address - Phone:732-383-4166
Practice Address - Fax:732-383-4171
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA076028002085B0100X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
H97322Medicare UPIN