Provider Demographics
NPI:1821310988
Name:R M BLATSTEIN DPM PA
Entity Type:Organization
Organization Name:R M BLATSTEIN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLATSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-225-3668
Mailing Address - Street 1:1635 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-7229
Mailing Address - Country:US
Mailing Address - Phone:772-225-3668
Mailing Address - Fax:772-334-4115
Practice Address - Street 1:1635 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-7229
Practice Address - Country:US
Practice Address - Phone:772-225-3668
Practice Address - Fax:772-334-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01563332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1117670001Medicare NSC
FL1821310988Medicare PIN