Basic Information
| Provider Information | |||||||||
| NPI: | 1386640993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLUESTEIN | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 POWERHOUSE RD | ||||||||
| Address2: | FL 3 | ||||||||
| City: | ROSLYN HTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115771324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166266366 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2401 W BELVEDERE AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106015209 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R149023 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 405623000 | 05 | MD | MEDICAID | 454MJ636 | 01 | MD | TRAILBLAZER | OTHER |