Provider Demographics
NPI:1720209521
Name:BLACKMAN, NOEL EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:EDWIN
Last Name:BLACKMAN
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 1:83 LAW ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-263-8123
Mailing Address - Fax:516-285-4949
Practice Address - Street 1:83 LAW ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:718-528-6277
Practice Address - Fax:516-285-4949
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141896208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00825810Medicaid
B88707Medicare UPIN
NY00825810Medicaid