Basic Information
| Provider Information | |||||||||
| NPI: | 1730383530 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLANCH | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | MALKA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 2ND AVE FL 9 | ||||||||
| Address2: | CENTER FOR COMPREHENSIVE HEALTH PRACTICE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100297406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123607893 | ||||||||
| FaxNumber: | 2123487253 | ||||||||
| Practice Location | |||||||||
| Address1: | 718 TEANECK RD | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018333000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 262783-1 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D71168 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 25MA09509100 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0054 | 01 | MD | BLUESHIELD | OTHER | 97161701 | 01 | DC | BLUESHIELD | OTHER | 510454800 | 05 | MD | MEDICAID |