Provider Demographics
NPI:1992971097
Name:BLATT, JEROLD (DC PT)
Entity type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:
Last Name:BLATT
Suffix:
Gender:M
Credentials:DC PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18417 UNION TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366
Mailing Address - Country:US
Mailing Address - Phone:718-454-0737
Mailing Address - Fax:718-454-1819
Practice Address - Street 1:18417 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1729
Practice Address - Country:US
Practice Address - Phone:718-454-0737
Practice Address - Fax:718-454-1819
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3458111N00000X
NY6047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65698GMedicare PIN