Provider Demographics
NPI:1548979404
Name:BLUME, RICHARD STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEPHEN
Last Name:BLUME
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 1:18 BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2803
Mailing Address - Country:US
Mailing Address - Phone:631-897-8324
Mailing Address - Fax:
Practice Address - Street 1:105 MAXESS RD STE 300
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3847
Practice Address - Country:US
Practice Address - Phone:631-897-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1689172083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine