Provider Demographics
NPI:1215918495
Name:BLUMENTHAL & ASSOCIATES DDS PC
Entity type:Organization
Organization Name:BLUMENTHAL & ASSOCIATES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-786-8667
Mailing Address - Street 1:3447 21ST ST
Mailing Address - Street 2:BLUMENTHAL AND ASSOCIATES DDS PC
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4721
Mailing Address - Country:US
Mailing Address - Phone:718-786-8667
Mailing Address - Fax:718-786-8531
Practice Address - Street 1:3447 21ST ST
Practice Address - Street 2:BLUMENTHAL AND ASSOCIATES DDS PC
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4721
Practice Address - Country:US
Practice Address - Phone:718-786-8667
Practice Address - Fax:718-786-8531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00748210Medicaid