Provider Demographics
NPI:1871500124
Name:BLACK, HOWARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:M
Last Name:BLACK
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 1:96 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2733
Mailing Address - Country:US
Mailing Address - Phone:518-563-8822
Mailing Address - Fax:518-562-3316
Practice Address - Street 1:96 COURT ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2733
Practice Address - Country:US
Practice Address - Phone:518-563-8822
Practice Address - Fax:518-562-3316
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129218207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00643105Medicaid
NYRB2779Medicare PIN
NYC49908Medicare UPIN
NY34206BMedicare ID - Type UnspecifiedMEDICARE