Edison R. Blanco Physician PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

189607 Issued in NY

Legal business name

EDISON R. BLANCO PHYSICIAN PC

Practice address

16 Brentwood Rd
Bay Shore, NY 11706-8011

Phone

(631) 969-7875

NPI assigned

Jun 2, 2008

Last updated

Sep 8, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edison Roque BlancoNPI 1184633687

Title

Owner

Phone

(631) 969-7875

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 6

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.

• Edison Roque Blanco, M.D.

  • Family Medicine Physician
  • Bay Shore, NY
  • NPI 1184633687
  Medicare reassignment NPD Authorized official
• Paul Joseph Brooke, DC

  • Rehabilitation Chiropractor
  • Bay Shore, NY
  • NPI 1275749426
  NPD (past)
• Peter Chiu, M.D.

  • Physical Medicine & Rehabilitation Physician
  • East Patchogue, NY
  • NPI 1306861802
  NPD (past)
• Michael Y Mizhiritsky, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • New York, NY
  • NPI 1942260419
  NPD (past)
• Donald John Wallace, DC

  • Rehabilitation Chiropractor
  • Smithtown, NY
  • NPI 1891856738
  NPD (past)
• Peter James Wynne, PA

  • Physician Assistant
  • Bellmore, NY
  • NPI 1215111455
  NPD (past)

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220832000000",
    "number": "1669631032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 BRENTWOOD RD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068011",
            "telephone_number": "631-969-7875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 BRENTWOOD RD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068011",
            "telephone_number": "631-969-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISON R. BLANCO PHYSICIAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-02",
        "last_updated": "2008-09-08",
        "status": "A",
        "authorized_official_last_name": "BLANCO",
        "authorized_official_first_name": "EDISON",
        "authorized_official_middle_name": "ROQUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-969-7875"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "189607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01634335",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shaelyn Dutton
• Sophia A Dwyer
• Karen M Eckardt, PT
• Candice Edelstein, M.S. CCC-SLP
• Christine Elizabeth Edelstein, MSED
• Norma Edmond
• Edward J Hallal Jr MD PC
• Edwardo M Yambo MD PC
• Alyssa Louise Edwards
• Sharlene Edwards

• Family Medicine Physician in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2008; 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.