Provider Demographics
NPI:1184800286
Name:ARNOLD BLANK MD LLC
Entity type:Organization
Organization Name:ARNOLD BLANK MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE STOCKHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-894-4997
Mailing Address - Street 1:370 RIVERSIDE DR
Mailing Address - Street 2:#14D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2179
Mailing Address - Country:US
Mailing Address - Phone:646-894-4997
Mailing Address - Fax:646-224-0984
Practice Address - Street 1:370 RIVERSIDE DR
Practice Address - Street 2:#14D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2179
Practice Address - Country:US
Practice Address - Phone:646-894-4997
Practice Address - Fax:646-224-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB58693Medicare UPIN