Provider Demographics
NPI:1730103805
Name:BLOBSTEIN, STEVEN (MD PHD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BLOBSTEIN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6703
Mailing Address - Country:US
Mailing Address - Phone:718-376-0500
Mailing Address - Fax:718-998-6393
Practice Address - Street 1:1463 E 17TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6703
Practice Address - Country:US
Practice Address - Phone:718-376-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147464207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00833069Medicaid
NY13D841Medicare ID - Type Unspecified
NY00833069Medicaid