Individual
DR. MIGUEL L BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
951 ROANOKE AVE, RIVERHEAD, NY 11901-2724
(631) 727-7773
(631) 369-4994
Mailing address
45 RESEARCH WAY, SUITE 204, EAST SETAUKET, NY 11733-6401
(631) 615-8272
(631) 350-7200
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
180073-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01231781
—
NY
Enumeration date
10/07/2005
Last updated
09/20/2013
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