Provider Demographics
NPI:1568441921
Name:BLUMENTHAL, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:BLUMENTHAL
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 1:98 WOODCHUCK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-2429
Mailing Address - Country:US
Mailing Address - Phone:516-499-3964
Mailing Address - Fax:516-570-7599
Practice Address - Street 1:98 WOODCHUCK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-2429
Practice Address - Country:US
Practice Address - Phone:516-499-3964
Practice Address - Fax:516-570-7599
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25030207RI0011X
NY181989207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02633636Medicaid
E97216Medicare UPIN
NY02633636Medicaid