Provider Demographics
NPI:1598778326
Name:BLASZKA, FREDERICK MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:MICHAEL
Last Name:BLASZKA
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 1:611 EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8703
Mailing Address - Country:US
Mailing Address - Phone:908-994-0120
Mailing Address - Fax:908-994-0131
Practice Address - Street 1:654 E JERSEY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206-1261
Practice Address - Country:US
Practice Address - Phone:908-994-0120
Practice Address - Fax:908-994-0131
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02971300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA02971300OtherMEDICAL LICENSE