Provider Demographics
NPI:1275596389
Name:BLITZ, LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:BLITZ
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 1:1777 HAMBURG TPKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5211
Mailing Address - Country:US
Mailing Address - Phone:973-831-7455
Mailing Address - Fax:973-831-7585
Practice Address - Street 1:1777 HAMBURG TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5211
Practice Address - Country:US
Practice Address - Phone:973-831-7455
Practice Address - Fax:973-831-7585
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ65348207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7726805Medicaid
NJ762764MDJMedicare PIN
NJ7726805Medicaid