Provider Demographics
NPI:1265403653
Name:BLUSH, JOEL (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:BLUSH
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 1:50 SEAVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4618
Mailing Address - Country:US
Mailing Address - Phone:516-484-6093
Mailing Address - Fax:516-484-6180
Practice Address - Street 1:50 SEAVIEW BLVD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4618
Practice Address - Country:US
Practice Address - Phone:516-484-6093
Practice Address - Fax:516-484-6180
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216555207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7736515OtherAETNA PPO
NY0132638OtherGHI PPO
NY02821272Medicaid
NY5C8296OtherHEALTHNET
NY201555-A11OtherHEALTHFIRST
NY216555OtherHIP
NY7X4521OtherEMPIRE BCBS
NYBJ6555OtherATLANTIS HEALTH PLAN
NYEVERCAREOther0410663
NYP3206060OtherOXFORD
NY00000011309OtherGHI HMO
NY185203OtherELDERPLAN
NY1403424OtherAETNA HMO
NY02821272Medicaid