Provider Demographics
NPI:1417012790
Name:DRS BLAU, TIGER, SULLIVAN, SUMNER
Entity Type:Organization
Organization Name:DRS BLAU, TIGER, SULLIVAN, SUMNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-541-6262
Mailing Address - Street 1:566 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5017
Mailing Address - Country:US
Mailing Address - Phone:516-544-6262
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:11758-5017
Practice Address - Country:US
Practice Address - Phone:516-544-6262
Practice Address - Fax:516-541-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty