Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 273750-1 | NY |
NPI | 1336431840 |
---|---|
Provider Name | Dr. Matthew J. Blitz |
First Address | Bay Shore, NY 11706-8441 |
Second Address | Bay Shore, NY 11706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2011 |
Last Update Date | 02/10/2019 |