Provider Demographics
NPI:1982959334
Name:HARVEY J BLUESTEIN MD LLC
Entity Type:Organization
Organization Name:HARVEY J BLUESTEIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BLUESTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-254-8557
Mailing Address - Street 1:325 REEF RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6537
Mailing Address - Country:US
Mailing Address - Phone:203-254-8557
Mailing Address - Fax:
Practice Address - Street 1:325 REEF RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6537
Practice Address - Country:US
Practice Address - Phone:203-254-8557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037483208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT240000139OtherMEDICARE
CT001374834Medicaid
CT001374834Medicaid