Provider Demographics
NPI:1760528780
Name:ROBERT A. BLOCK PHD PC
Entity Type:Organization
Organization Name:ROBERT A. BLOCK PHD PC
Other - Org Name:AZNY PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:6024-390-9475
Mailing Address - Street 1:5757 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE W401
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4641
Mailing Address - Country:US
Mailing Address - Phone:602-439-0475
Mailing Address - Fax:602-439-0106
Practice Address - Street 1:5757 W THUNDERBIRD RD
Practice Address - Street 2:SUITE W401
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4641
Practice Address - Country:US
Practice Address - Phone:602-439-0475
Practice Address - Fax:602-439-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ83278Medicare PIN