Provider Demographics
NPI:1417382193
Name:BLUMENKRANTZ, INGRID MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:MARIA
Last Name:BLUMENKRANTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 W SHORE RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3012
Mailing Address - Country:US
Mailing Address - Phone:516-883-4757
Mailing Address - Fax:
Practice Address - Street 1:31 W SHORE RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3012
Practice Address - Country:US
Practice Address - Phone:516-883-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126421283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital