Provider Demographics
NPI:1962732735
Name:BLOG, DEBRA (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:BLOG
Suffix:
Gender:F
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:BUREAU OF IMMUNIZATION NEW YORK STATE DEPT OFHEALTH
Mailing Address - Street 2:EMPIRE STATE PLAZA, CORNING TOWER, ROOM 649
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12237-0001
Mailing Address - Country:US
Mailing Address - Phone:518-473-4437
Mailing Address - Fax:
Practice Address - Street 1:BUREAU OF IMMUNIZATION NEW YORK STATE DEPT OFHEALTH
Practice Address - Street 2:EMPIRE STATE PLAZA, CORNING TOWER, ROOM 649
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12237-0001
Practice Address - Country:US
Practice Address - Phone:518-473-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179674-1208000000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics