Provider Demographics
NPI:1568497881
Name:GOLDBLATT, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:GOLDBLATT
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 1:18 RYE RIDGE PLAZA
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573
Mailing Address - Country:US
Mailing Address - Phone:914-253-9252
Mailing Address - Fax:914-253-9251
Practice Address - Street 1:18 RYE RIDGE PLAZA
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-253-9252
Practice Address - Fax:914-253-9251
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125876207RG0100X
CT018598207RG0100X
FLME26108207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00502823Medicaid
NYP00105669OtherRAILROAD MEDICARE
CTP00076235OtherRAILROAD MEDICARE
NY3V8391OtherBLUE CROSS
CT010125876NY03OtherANTHEM BC
A98915Medicare UPIN
NY3V3371Medicare ID - Type Unspecified
NY00502823Medicaid