Provider Demographics
NPI:1619963899
Name:GREENBLATT, HENRY A (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:A
Last Name:GREENBLATT
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 1:400 GIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3701
Mailing Address - Country:US
Mailing Address - Phone:845-561-1565
Mailing Address - Fax:845-561-1578
Practice Address - Street 1:400 GIDNEY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3701
Practice Address - Country:US
Practice Address - Phone:845-561-1565
Practice Address - Fax:845-561-1578
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161043207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01223005Medicaid
NY900361OtherMVP INSURANCE
NY900361OtherMVP INSURANCE
NY01223005Medicaid