Provider Demographics
NPI:1528134830
Name:BLUESTEIN, HARVEY JAY (MD)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:JAY
Last Name:BLUESTEIN
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 1:325 REEF RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6537
Mailing Address - Country:US
Mailing Address - Phone:203-254-8557
Mailing Address - Fax:203-256-3333
Practice Address - Street 1:325 REEF RD
Practice Address - Street 2:SUITE #105
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6537
Practice Address - Country:US
Practice Address - Phone:203-254-8557
Practice Address - Fax:203-256-3333
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037483208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT037483OtherCONNECTICARE
CTOV 6863OtherHEALTHNET
CT6920834004OtherCIGNA
CT2165611OtherAETNA
CT001374834Medicaid
CT010037483OtherANTHEM BLUE CROSS
G93690Medicare UPIN
CTOV 6863OtherHEALTHNET