Provider Demographics
NPI:1265578926
Name:BLECHER, MALCOLM ROGER (MD)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:ROGER
Last Name:BLECHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10628 QUEENS BLVD
Mailing Address - Street 2:PO BOX 750273
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4248
Mailing Address - Country:US
Mailing Address - Phone:718-793-0795
Mailing Address - Fax:718-793-0795
Practice Address - Street 1:8452 63RD AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1967
Practice Address - Country:US
Practice Address - Phone:718-793-0795
Practice Address - Fax:718-793-0795
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY164407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY93585 79 11Medicare ID - Type Unspecified
NY14G763Medicare ID - Type UnspecifiedBC MEDICARE
NYE56355Medicare UPIN