Individual
THEODORE BLASZCZYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 E MAIN ST STE 1E, SMITHTOWN, NY 11787
(631) 265-4567
(631) 265-4704
Mailing address
45 RESEARCH WAY STE 208A, EAST SETAUKET, NY 11733-6401
(631) 675-2125
(631) 675-2628
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
169211
NY
207VG0400X
Gynecology Physician
169211
NY
207VX0000X
Obstetrics Physician
169211
NY
Other
Enumeration date
10/27/2006
Last updated
04/27/2022
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