Provider Demographics
NPI:1447793534
Name:BLATTER, CHANA MIRIAM (MED, SPECIAL ED)
Entity Type:Individual
Prefix:MS
First Name:CHANA
Middle Name:MIRIAM
Last Name:BLATTER
Suffix:
Gender:F
Credentials:MED, SPECIAL ED
Other - Prefix:MRS
Other - First Name:CHANA
Other - Middle Name:MIRIAM
Other - Last Name:AXELROD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, SPECIAL ED
Mailing Address - Street 1:162 BEAUMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4119
Mailing Address - Country:US
Mailing Address - Phone:347-549-1290
Mailing Address - Fax:
Practice Address - Street 1:162 BEAUMONT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4119
Practice Address - Country:US
Practice Address - Phone:347-549-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1078636161390200000X
NY1078300161390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program