Provider Demographics
NPI:1457491458
Name:GOLDBLATT, WENDY GAIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:GAIL
Last Name:GOLDBLATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 NEW YORK AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3304
Mailing Address - Country:US
Mailing Address - Phone:631-673-3239
Mailing Address - Fax:631-427-4005
Practice Address - Street 1:356 NEW YORK AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3304
Practice Address - Country:US
Practice Address - Phone:631-673-3239
Practice Address - Fax:631-427-4005
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV22771Medicare ID - Type UnspecifiedPSYCHOLOGIST