Provider Demographics
NPI:1275562894
Name:BLITZ-SHABBIR, KAREN (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BLITZ-SHABBIR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-7247
Mailing Address - Country:US
Mailing Address - Phone:718-246-8614
Mailing Address - Fax:718-246-8592
Practice Address - Street 1:263 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7247
Practice Address - Country:US
Practice Address - Phone:718-246-8614
Practice Address - Fax:718-246-8592
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1907492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
01J441Medicare ID - Type Unspecified
F77643Medicare UPIN