Provider Demographics
NPI:1730149469
Name:BLAU, JEFFREY STEVEN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEVEN
Last Name:BLAU
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 1:40 HART ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1743
Mailing Address - Country:US
Mailing Address - Phone:860-229-2059
Mailing Address - Fax:860-229-8495
Practice Address - Street 1:40 HART ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1743
Practice Address - Country:US
Practice Address - Phone:860-229-2059
Practice Address - Fax:860-229-8495
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0139802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300023206OtherRAILROAD MEDICARE
CT010013980CT03OtherANTHEM BC/BS
CT010013980CT06OtherANTHEM BC/BS
CT010013980CT15OtherANTHEM BC/BS
CT001139807Medicaid
CT010013980CT16OtherANTHEM BC/BS
CT300047492OtherRAILROAD MEDICARE
CT010013980CT07OtherANTHEM BC/BS
CT3000104747OtherRAILROAD MEDICARE
CT010013980CT04OtherANTHEM BC/BS
CT300000122Medicare ID - Type Unspecified
CT300000925Medicare PIN
CT300000939Medicare PIN
CT010013980CT07OtherANTHEM BC/BS
CT300000953Medicare PIN
CT300047492OtherRAILROAD MEDICARE