Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 111159 | NY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 111159 | NY |
N | 207R00000X | Internist | 111159 | NY |
N | 111NI0900X | Internist | 111159 | NY |
N | 208D00000X | General Practice Physician | 111159 | NY |
NPI | 1326029570 |
---|---|
Provider Name | Dr. Isaac Blum |
First Address | Scarsdale, NY 10583-7613 |
Second Address | Bronx, NY 10459-4240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 18/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00696240 | (05) | NY |
B78722 | (02) | NY |