Provider Demographics
NPI:1972590511
Name:BLUM, DANIEL N (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:N
Last Name:BLUM
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 1:13806 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1933
Mailing Address - Country:US
Mailing Address - Phone:718-520-0248
Mailing Address - Fax:718-544-2725
Practice Address - Street 1:13806 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1933
Practice Address - Country:US
Practice Address - Phone:718-520-0248
Practice Address - Fax:718-544-2725
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12131Medicare PIN
B87318Medicare UPIN