Basic Information
| Provider Information | |||||||||
| NPI: | 1265489215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUMENTHAL | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3435 WINCHESTER RD | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3701 CORRIERE RD STE 22 | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180457991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845917170 | ||||||||
| FaxNumber: | 4845917171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MA49210 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD042352E | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0823201 | 05 | NJ | MEDICAID | 3709196001 | 01 | PA | BCBS-PA KEYSTONE EAST & AMERIHEALTH | OTHER | 0823204 | 05 | NJ | MEDICAID | 50092112 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 160057252 | 01 | NJ | RAILROAD MEDICARE | OTHER | 204820112-B | 01 | NJ | HORIZON BC OF NJ | OTHER | 528714 | 01 | PA | HIGHMARK BS | OTHER |