Provider Demographics
NPI:1285899351
Name:BLUMBERG, NATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:BLUMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 THATCH POND RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1828
Mailing Address - Country:US
Mailing Address - Phone:631-360-1712
Mailing Address - Fax:631-265-2713
Practice Address - Street 1:14 THATCH POND RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1828
Practice Address - Country:US
Practice Address - Phone:631-360-1712
Practice Address - Fax:631-265-2713
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD84443208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology