Provider Demographics
NPI:1023162773
Name:BLOCK, SEYMOUR H (DO)
Entity type:Individual
Prefix:
First Name:SEYMOUR
Middle Name:H
Last Name:BLOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E SHORE RD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2432
Mailing Address - Country:US
Mailing Address - Phone:516-829-8067
Mailing Address - Fax:516-829-8078
Practice Address - Street 1:310 E SHORE RD
Practice Address - Street 2:SUITE #201
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2432
Practice Address - Country:US
Practice Address - Phone:516-829-8067
Practice Address - Fax:516-829-8078
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1162422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY318731OtherBLUE CROSS
NY318731Medicare ID - Type UnspecifiedMEDICARE
NYC08352Medicare UPIN