Organization
AMBULATORY MEDICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MORDECAI BLUTH M.D. (DIRECTOR)
(718) 815-1000
Entity
Organization
Contact information
Practice address
187 VETERANS BLVD, MASSAPEQUA, NY 11758-4982
(718) 815-1000
(718) 815-8122
Mailing address
302 MANOR RD, STATEN ISLAND, NY 10314-2408
(718) 815-1000
(718) 815-8122
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
06/17/2006
Last updated
07/23/2008
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