Provider Demographics
NPI:1376607267
Name:BLAU, SHELDON P (MD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:P
Last Name:BLAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:566 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-541-6262
Mailing Address - Fax:516-541-0011
Practice Address - Street 1:566 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-541-6262
Practice Address - Fax:516-541-0011
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY087639207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD46637Medicare UPIN
NY174561Medicare ID - Type Unspecified