| Edison R. Blanco Physician Pc | |
|
16 Brentwood Rd Bay Shore NY 11706-8011 | |
| (631) 969-7875 | |
| Not Available |
| Full Name | Edison R. Blanco Physician Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 16 Brentwood Rd, Bay Shore, New York |
| Authorized Official Name and Position | Edison Roque Blanco (OWNER) |
| Authorized Official Contact | 6319697875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edison R. Blanco Physician Pc 16 Brentwood Rd Bay Shore NY 11706-8011 Ph: (631) 969-7875 | Edison R. Blanco Physician Pc 16 Brentwood Rd Bay Shore NY 11706-8011 Ph: (631) 969-7875 |
| NPI Number | 1669631032 |
|---|---|
| Provider Enumeration Date | 06/02/2008 |
| Last Update Date | 09/08/2008 |
| Medicare PECOS PAC ID | 9830131838 |
|---|---|
| Medicare Enrollment ID | O20050601000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669631032 | NPI | - | NPPES |
| 01634335 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 189607 (New York) | Primary |
| Provider Name | Edison R Blanco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184633687 PECOS PAC ID: 4183666183 Enrollment ID: I20050603000564 |
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