Provider Demographics
NPI:1447839923
Name:GREENBLATT, LOGAN BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:BENJAMIN
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 CENTRAL PARK W APT 18R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 PLAIN STREET 3RD FLOOR SUITE 101
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02902-3436
Practice Address - Country:US
Practice Address - Phone:401-444-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330544208000000X
RILP064892080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology