Provider Demographics
NPI:1457417776
Name:BLAU, MORDCAI (MD, PC)
Entity Type:Individual
Prefix:DR
First Name:MORDCAI
Middle Name:
Last Name:BLAU
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GREENRIDGE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1238
Mailing Address - Country:US
Mailing Address - Phone:914-428-4700
Mailing Address - Fax:914-428-6971
Practice Address - Street 1:12 GREENRIDGE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1238
Practice Address - Country:US
Practice Address - Phone:914-428-4700
Practice Address - Fax:914-428-6971
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135936261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO7710Medicare UPIN
NY28A331Medicare ID - Type Unspecified