Provider Demographics
NPI:1962426338
Name:BLUMENTHAL, ANDREW M (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:BLUMENTHAL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:805 COOPER RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-751-1777
Mailing Address - Fax:856-751-8090
Practice Address - Street 1:805 COOPER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-751-1777
Practice Address - Fax:856-751-8090
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMB06825300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5520304Medicaid
NJ558697OtherGROUP PTAN
H25409Medicare UPIN