Provider Demographics
NPI:1235172131
Name:BLUMENSTYK, MICHELLE K (OTR, CHT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:K
Last Name:BLUMENSTYK
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3574
Mailing Address - Country:US
Mailing Address - Phone:201-503-0291
Mailing Address - Fax:201-503-0293
Practice Address - Street 1:106 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3574
Practice Address - Country:US
Practice Address - Phone:201-503-0291
Practice Address - Fax:201-503-0293
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00017700225X00000X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3604499OtherOXFORD
NJ202370196OtherHORIZON BLUE CROSS
NJJ36533OtherHEALTHNET
NJ5780436OtherAETNA
NJJ36533OtherHEALTHNET
NJ1487874202Medicare NSC