Provider Demographics
NPI:1992763999
Name:BLANK, HOWARD L (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:L
Last Name:BLANK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:120 MILLBURN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1994
Mailing Address - Country:US
Mailing Address - Phone:973-467-1212
Mailing Address - Fax:973-467-1216
Practice Address - Street 1:120 MILLBURN AVE
Practice Address - Street 2:STE 103
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-467-1212
Practice Address - Fax:973-467-1212
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-09-27
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Provider Licenses
StateLicense IDTaxonomies
NJMA037301207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0511404Medicaid
NJ0511404Medicaid
C60531Medicare UPIN