Edison R. Blanco Physician Pc

LBN: Edison R. Blanco Physician Pc
Edison R. Blanco Physician Pc is an health care organization with primary practice located at 16 Brentwood Rd , Bay Shore NY 11706-8011. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Edison R. Blanco Physician Pc can be contacted via phone (631) 969-7875, or through Blanco, Edison Roque via phone (631) 969-7875.

Contact Information

Primary practice address
16 Brentwood Rd Bay Shore NY 11706-8011
Phone: (631) 969-7875
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Blanco, Edison Roque
Phone: (631) 969-7875

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 189607 New York

Profile Details

NPI number 1669631032
LBN Legal business name Edison R. Blanco Physician Pc
DBA Doing business as
Authorized official Blanco, Edison Roque
Entity Organization
Organization subpart 1 No
Enumeration date Jun 2nd, 2008
Last updated Sep 8th, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669631032 NPPES
New York MEDICAID 01634335

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