Provider Demographics
NPI:1790983070
Name:BLUM, SUSAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:BLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 RYE RIDGE PLZ
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2820
Mailing Address - Country:US
Mailing Address - Phone:914-652-7800
Mailing Address - Fax:914-652-7795
Practice Address - Street 1:34 RYE RIDGE PLZ
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2820
Practice Address - Country:US
Practice Address - Phone:914-652-7800
Practice Address - Fax:914-652-7795
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1777802083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine