Provider Demographics
NPI:1871877142
Name:JOSEPH A BLANCO M D P C
Entity type:Organization
Organization Name:JOSEPH A BLANCO M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-627-0033
Mailing Address - Street 1:133 PLANDOME RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2331
Mailing Address - Country:US
Mailing Address - Phone:516-627-0033
Mailing Address - Fax:516-627-7354
Practice Address - Street 1:133 PLANDOME RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2331
Practice Address - Country:US
Practice Address - Phone:516-627-0033
Practice Address - Fax:516-627-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0709499Medicaid
B73536Medicare UPIN
NY0709499Medicaid