Basic Information
| Provider Information | |||||||||
| NPI: | 1275831562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLINDER | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | JACOB | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 WELCH RD | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504978000 | ||||||||
| FaxNumber: | 2674259299 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 WELCH RD | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504978000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2011 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 239762 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | MD426797 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 2080P0202X | C174470 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 208000000X | C174470 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.