Provider Demographics
NPI:1154591352
Name:GAIL M BLUMENTHAL OD PA
Entity type:Organization
Organization Name:GAIL M BLUMENTHAL OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-894-1400
Mailing Address - Street 1:17 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3508
Mailing Address - Country:US
Mailing Address - Phone:201-894-1400
Mailing Address - Fax:201-894-0220
Practice Address - Street 1:17 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3508
Practice Address - Country:US
Practice Address - Phone:201-894-1400
Practice Address - Fax:201-894-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00395300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ224026220OtherHORIZON BLUE CROSS BLUE SHIELD
NJU02329Medicare UPIN
NJ123144Medicare PIN