Provider Demographics
NPI:1548247125
Name:BLANCK, RICHARD H (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:BLANCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1991 MARCUS AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2057
Mailing Address - Country:US
Mailing Address - Phone:516-466-4700
Mailing Address - Fax:516-466-4810
Practice Address - Street 1:1991 MARCUS AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-2057
Practice Address - Country:US
Practice Address - Phone:516-466-4700
Practice Address - Fax:516-466-4810
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120724174400000X
NY120724-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0266413002OtherCIGNA HEALTHCARE
NY887956OtherAETNA HMO
NYAS1292OtherOXFORD HEALTH PLAN
NY112434927OtherANTHEM HEALTH NETWORK
NY112434927OtherBEECH STREET CORPORATION
NY112434927OtherMULTIPLAN
NY112434927OtherPHCS
NY112434927OtherFIRST HEALTH
NY173484OtherEMPIRE PLAN/UNITED HEALTH
NY0350431OtherEMPIRE HEALTHCHOICE
NY112434927OtherHORIZON HEALTHCARE
NY112434927OtherSELECT PRO
NY112434927OtherTPA/BENESIGHT
NYOC2810OtherPHS/ACS
NY112434927OtherONE HEALTH PLAN
NY4394255OtherAETNA MC/PPO/EPO
NY173484OtherEMPIRE PLAN/UNITED HEALTH
NYAS1292OtherOXFORD HEALTH PLAN
NYB13600Medicare UPIN
350431Medicare Oscar/Certification