Phillip Erwin Korenblat, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

1040 N Mason Rd
Suite 112
Saint Louis, MO 63141-6399

Phone

(314) 514-8509

Fax

(314) 542-0109

NPI assigned

Feb 14, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456099200000",
    "number": "1063555860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 N MASON RD",
            "address_2": "SUITE 112",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416399",
            "telephone_number": "314-514-8509",
            "fax_number": "314-542-0109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 N MASON RD",
            "address_2": "SUITE 112",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416399",
            "telephone_number": "314-514-8509",
            "fax_number": "314-542-0109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORENBLAT",
        "first_name": "PHILLIP",
        "middle_name": "ERWIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2016-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ray John Kopsky, PH.D., MSW
• Korede Foundation
• Korede Inc.
• Melissa Korenblat-Hanin, MSW, LCSW
• Kevin M Korenblat, MD
• Elizabeth Koritz, LPC
• Vasilisa Alexandra Kormendi, MD
• Theresa C Kormos, MSN, RN
• Elliot Lawrence Korn, M.D.
• Valarie Kornblet, CNC

• Specialist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.