Provider Demographics
NPI:1750446241
Name:BLANK, HOWARD MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MICHAEL
Last Name:BLANK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1060
Mailing Address - Country:US
Mailing Address - Phone:914-358-4018
Mailing Address - Fax:914-358-4020
Practice Address - Street 1:455 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1060
Practice Address - Country:US
Practice Address - Phone:914-358-4018
Practice Address - Fax:914-358-4020
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003068213E00000X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51118Medicare UPIN
NYP37041Medicare ID - Type Unspecified