Provider Demographics
NPI:1942447602
Name:MAX & BLOM MD PC
Entity Type:Organization
Organization Name:MAX & BLOM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-624-8110
Mailing Address - Street 1:1676 SUNSET AVE
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5416
Mailing Address - Country:US
Mailing Address - Phone:315-624-8110
Mailing Address - Fax:315-624-8115
Practice Address - Street 1:1676 SUNSET AVE
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5416
Practice Address - Country:US
Practice Address - Phone:315-624-8110
Practice Address - Fax:315-624-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty