Provider Demographics
NPI:1114023520
Name:BLITZER, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BLITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE STE 613
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1962
Mailing Address - Country:US
Mailing Address - Phone:212-262-9500
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE STE 613
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1962
Practice Address - Country:US
Practice Address - Phone:212-262-4444
Practice Address - Fax:212-523-8165
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJW23126514C207Y00000X
NY120296207Y00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00250197Medicaid
NYA62262Medicare UPIN
NYW5F051Medicare PIN
NY00250197Medicaid