Provider Demographics
NPI:1790717114
Name:BLOCH, JAY LAURENCE (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:LAURENCE
Last Name:BLOCH
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 1:409 ROUTE 70 E
Mailing Address - Street 2:SUITE #508
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2413
Mailing Address - Country:US
Mailing Address - Phone:856-651-0500
Mailing Address - Fax:856-651-0700
Practice Address - Street 1:2301 EVESHAM ROAD
Practice Address - Street 2:SUITE #508
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4506
Practice Address - Country:US
Practice Address - Phone:856-651-0500
Practice Address - Fax:856-651-0700
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA49807208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3612201Medicaid
NJBL577825Medicare ID - Type Unspecified
NJ3612201Medicaid