Individual
MR. DENNIS BLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2202 GENESEE ST, UTICA, NY 13502
(315) 732-0349
(315) 732-0309
Mailing address
2202 GENESEE ST, UTICA, NY 13502
(315) 732-0349
(315) 732-0309
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
1060363A
IN
208600000X
Surgery Physician
Primary
196361
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03107559
—
NY
Enumeration date
05/03/2006
Last updated
09/11/2018
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