Provider Demographics
NPI:1053405498
Name:BLAZEY, WILLIAM RAYMOND (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RAYMOND
Last Name:BLAZEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHERN BLVD
Mailing Address - Street 2:ACADEMIC HEALTH CARE CENTER
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-8000
Mailing Address - Country:US
Mailing Address - Phone:516-686-1300
Mailing Address - Fax:516-686-7890
Practice Address - Street 1:NORTHERN BLVD
Practice Address - Street 2:ACADEMIC HEALTH CARE CENTER
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-8000
Practice Address - Country:US
Practice Address - Phone:516-686-1300
Practice Address - Fax:516-686-7890
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine