Provider Demographics
NPI:1710118138
Name:WILLIAM G GOLDBLATT DPM A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WILLIAM G GOLDBLATT DPM A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A PROFESSIONAL CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:GOLDBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:909-592-4438
Mailing Address - Street 1:322 N SAN DIMAS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2601
Mailing Address - Country:US
Mailing Address - Phone:909-592-4438
Mailing Address - Fax:909-592-4439
Practice Address - Street 1:322 N SAN DIMAS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2601
Practice Address - Country:US
Practice Address - Phone:909-592-4438
Practice Address - Fax:909-592-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty