Provider Demographics
NPI:1619007200
Name:BLATT, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BLATT
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 1:300 MERCER STREET
Mailing Address - Street 2:SUITE 29H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6742
Mailing Address - Country:US
Mailing Address - Phone:212-260-0906
Mailing Address - Fax:
Practice Address - Street 1:300 MERCER STREET
Practice Address - Street 2:SUITE 29H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6742
Practice Address - Country:US
Practice Address - Phone:212-260-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098813207R00000X
CAGFE22042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B78857Medicare UPIN
NY660221Medicare ID - Type Unspecified