Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Edison Roque Blanco, MD

Individual provider Family Medicine Physician · NPI 1184633687

Dr. Edison Roque Blanco, MD is a Family Practice in Bay Shore, New York. Qualified in 1976, 50 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in New York.

Years since qualifying
50
Licensed in
NY
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

16 Brentwood Rd
Bay Shore, NY 11706-8011
Phone: (631) 969-7875
Fax: (631) 969-7883
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 189607 (NY)

Record details

NPI number1184633687
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedAugust 5, 2006
Last updated in NPPESJuly 8, 2007
Mailing address16 Brentwood Rd, Bay Shore, NY 11706-8011

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 1976 (50 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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