Organization Active NPI

Lawrence Blum, M.D., P.C

  • Ophthalmology Physician
  • New York, NY
National Provider Identifier
1417381880
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
188611 Issued in NY
Legal business name
LAWRENCE BLUM, M.D., P.C
Practice address
572 Park Ave.
Ground FL
New York, NY 10065
Phone
(212) 751-8374
Fax
(212) 751-8374
NPI assigned
Aug 21, 2013
Last updated
Aug 21, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

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

Authorized official

Name
Ms. Deborah Varela
Title
Billing Manager
Phone
(212) 751-8374

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 188611 NY Primary

Addresses

Primary practice location

572 Park Ave.
Ground FL
New York, NY 10065

Mailing address

572 Park Ave.
Ground FL
New York, NY 10065
Phone (212) 751-8374

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131121000332 NY Part B Supplier - Clinic/Group Practice 9739315789 Receives reassigned benefits from 2 practitioners
Practice locations: New York, NY; Kew Gardens, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377043200000",
    "number": "1417381880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "572 PARK AVE.",
            "address_2": "GROUND FL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10065",
            "telephone_number": "212-751-8374",
            "fax_number": "212-751-8374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "572 PARK AVE.",
            "address_2": "GROUND FL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10065",
            "telephone_number": "212-751-8374",
            "fax_number": "212-751-8374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE BLUM, M.D., P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-21",
        "last_updated": "2013-08-21",
        "status": "A",
        "authorized_official_last_name": "VARELA",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "212-751-8374",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "188611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.