Provider Demographics
NPI:1821086463
Name:BLEIMAN, MICHAEL IRA (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IRA
Last Name:BLEIMAN
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 S LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2923
Mailing Address - Country:US
Mailing Address - Phone:609-709-9121
Mailing Address - Fax:
Practice Address - Street 1:1100 ROUTE 72 W
Practice Address - Street 2:SUITE 304
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2468
Practice Address - Country:US
Practice Address - Phone:609-978-9639
Practice Address - Fax:609-978-9685
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06787800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6947107Medicaid
NJG33187Medicare UPIN
NJ091916UBGMedicare ID - Type Unspecified