Provider Demographics
NPI:1699758631
Name:BLUM, ALAN I (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:I
Last Name:BLUM
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 1:444 MERRICK RD
Mailing Address - Street 2:LOWER LEVEL 1
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:516-593-9500
Mailing Address - Fax:516-593-9048
Practice Address - Street 1:444 MERRICK RD
Practice Address - Street 2:LOWER LEVEL 1
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-593-9500
Practice Address - Fax:516-593-9048
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136083207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00765839Medicaid
93A821Medicare ID - Type Unspecified
NY00765839Medicaid