Provider Demographics
NPI:1730383530
Name:BLANCH, TANYA MALKA (MD)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MALKA
Last Name:BLANCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 2ND AVE FL 9
Mailing Address - Street 2:CENTER FOR COMPREHENSIVE HEALTH PRACTICE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7406
Mailing Address - Country:US
Mailing Address - Phone:212-360-7893
Mailing Address - Fax:212-348-7253
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-833-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262783-1207R00000X
MDD71168207R00000X
390200000X
NJ25MA09509100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0054OtherBLUESHIELD
DC97161701OtherBLUESHIELD
MD510454800Medicaid
MD510454800Medicaid