Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MA 40974 | NJ |
NPI | 1104897339 |
---|---|
Provider Name | Scott Blumberg |
First Address | Philadelphia, PA 19118-8055 |
Second Address | Toms River, NJ 08753-8130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 19/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3369404 | (05) | NJ |
D19255 | (02) | NJ |