Provider Demographics
NPI:1750483483
Name:GREENBLATT, MICHAEL NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NOEL
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:133 BILTMORE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-789-4121
Mailing Address - Fax:516-795-0479
Practice Address - Street 1:100 EAST 77TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-434-2972
Practice Address - Fax:212-434-3832
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY092850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01407941Medicaid
NY592331Medicare PIN
NY01407941Medicaid