Provider Demographics
NPI:1700876513
Name:BLINDERMAN, BRIAN SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SETH
Last Name:BLINDERMAN
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 1:1575 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1428
Mailing Address - Country:US
Mailing Address - Phone:516-374-0555
Mailing Address - Fax:516-374-7639
Practice Address - Street 1:1575 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1428
Practice Address - Country:US
Practice Address - Phone:516-374-0555
Practice Address - Fax:516-374-7639
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143805208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B10749Medicare UPIN