Provider Demographics
NPI:1407841588
Name:BLUM, EDWARD (PT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BLUM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2053
Mailing Address - Country:US
Mailing Address - Phone:718-822-2281
Mailing Address - Fax:718-587-8485
Practice Address - Street 1:3611 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2053
Practice Address - Country:US
Practice Address - Phone:718-904-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0067451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0469643000OtherAMERIHEALTH #
NY128588OtherMPN #
NY5526049OtherAETNA PPO #
NY109258200OtherDEPARTMENT OF LABOR #
NYQ6643OtherEMPIRE #
NY006754-A81OtherHEALTHFIRST #
NY0125088OtherAETNA HMO #
NY133586197OtherTAX IDENTIFICATION #
NY1000001747OtherAFFINITY #
NY2C1509OtherHEALTHNET #
NY0469643000OtherAMERIHEALTH #
NY109258200OtherDEPARTMENT OF LABOR #