Individual provider Active NPI

David L Blecker, MD

  • Nephrology Physician
  • Northfield, NJ
National Provider Identifier
1245249473
Registry record updated Feb 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MA 34493 Issued in NJ
Practice address
510 Jackson Ave
Northfield, NJ 08225
Phone
(609) 303-0200
Fax
(609) 383-8352
NPI assigned
Aug 5, 2006
Last updated
Feb 28, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X MA 34493 NJ Primary

Addresses

Primary practice location

510 Jackson Ave
Northfield, NJ 08225

Mailing address

510 Jackson Ave
Northfield, NJ 08225
Phone (609) 303-0200

Other identifiers 1

IdentifierTypeStateIssuer
3787508MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA 34493NJMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Kidney Care LLC Nephrology PastSince Apr 1, 2024 Accepting new patients
Kidney and Hypertension Specialists, P.a. Nephrology Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298851200000",
    "number": "1245249473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 JACKSON AVE",
            "city": "NORTHFIELD",
            "state": "NJ",
            "postal_code": "08225",
            "telephone_number": "609-303-0200",
            "fax_number": "609-383-8352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 JACKSON AVE",
            "city": "NORTHFIELD",
            "state": "NJ",
            "postal_code": "08225",
            "telephone_number": "609-303-0200",
            "fax_number": "609-383-8352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLECKER",
        "first_name": "DAVID",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2011-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "MA 34493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3787508",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northfield, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.