Provider Demographics
NPI:1851493258
Name:KORNBLUH, EDWARD C (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:KORNBLUH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 MADISON AVE
Mailing Address - Street 2:15 FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-753-7400
Mailing Address - Fax:212-753-7402
Practice Address - Street 1:424 MADISON AVE
Practice Address - Street 2:15 FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-753-7400
Practice Address - Fax:212-753-7402
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist