Provider Demographics
NPI:1386646016
Name:BLUM, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:BLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 GEORGES RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3377
Mailing Address - Country:US
Mailing Address - Phone:732-745-4994
Mailing Address - Fax:732-745-7044
Practice Address - Street 1:69 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3953
Practice Address - Country:US
Practice Address - Phone:732-494-3220
Practice Address - Fax:732-494-5057
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34875207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0421405Medicaid
NJD20067Medicare UPIN
NJ875774Medicare PIN