Jerry G Blaivas MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

60144945 Issued in NY

Legal business name

JERRY G BLAIVAS MD

Practice address

445 E 77TH St
New York, NY 10021-2318

Phone

(212) 772-3900

Fax

(212) 772-1919

NPI assigned

Apr 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jerry G Blaivas, M.D.

Title

President

Phone

(212) 772-3900

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831211663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100212318",
            "telephone_number": "212-772-3900",
            "fax_number": "212-772-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100212318",
            "telephone_number": "212-772-3900",
            "fax_number": "212-772-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY G BLAIVAS MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLAIVAS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-772-3900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "NY",
            "license": "60144945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ilana Esther Jerud
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• Urology Physician in New York, NY
• Providers in New York, NY by specialty
• Urology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.