Provider Demographics
NPI:1013031483
Name:BLITZ, JENNIFER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:BLITZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORMA LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4520
Mailing Address - Country:US
Mailing Address - Phone:631-742-8523
Mailing Address - Fax:631-979-0438
Practice Address - Street 1:111 SMITHTOWN BYP
Practice Address - Street 2:SUITE 121
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2524
Practice Address - Country:US
Practice Address - Phone:631-742-8523
Practice Address - Fax:631-979-0438
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3479888OtherOXFORD HEALTH PLANS
NY041691OtherVALUEOPTIONS
NYP3479888OtherOXFORD HEALTH PLANS