Provider Demographics
NPI:1467546705
Name:KORNBLITH, SANDER JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDER
Middle Name:JAY
Last Name:KORNBLITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BLAW AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3216
Mailing Address - Country:US
Mailing Address - Phone:412-559-4364
Mailing Address - Fax:412-968-0527
Practice Address - Street 1:700 BLAW AVE STE 201
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3216
Practice Address - Country:US
Practice Address - Phone:412-967-0610
Practice Address - Fax:412-968-0527
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003630L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
034250OtherHIGHMARK