Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 013716 | NY |
Y | 103TC0700X | Clinical Psychologist | 013716 | NY |
NPI | 1013031483 |
---|---|
Provider Name | Dr. Jennifer Blitz |
First Address | Kings Park, NY 11754-4520 |
Second Address | Hauppauge, NY 11788-2524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 25/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041691 | VALUEOPTIONS (01) | NY |
P3479888 | OXFORD HEALTH PLANS (01) | NY |