Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 25MA03591000 | NJ |
NPI | 1013074988 |
---|---|
Provider Name | Dr. Jay Richard Blum |
First Address | Highland Park, NJ 08904-2439 |
Second Address | Highland Park, NJ 08904-2439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52679 | (02) | NJ |