Provider Demographics
NPI:1407860570
Name:WEINBLATT, MARK EFRAIM (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EFRAIM
Last Name:WEINBLATT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 611
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3808
Mailing Address - Country:US
Mailing Address - Phone:516-663-2532
Mailing Address - Fax:516-663-2233
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 460
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4064
Practice Address - Country:US
Practice Address - Phone:516-663-9400
Practice Address - Fax:516-663-9482
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1312402080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01380125Medicaid
NY61A751Medicare ID - Type Unspecified
NY01380125Medicaid