Provider Demographics
NPI:1518076603
Name:BLITZ, JEANNA DIANNE (MD)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:DIANNE
Last Name:BLITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANNA
Other - Middle Name:DIANNE
Other - Last Name:VIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:560 1ST AVE
Mailing Address - Street 2:RR 607
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-5072
Mailing Address - Fax:
Practice Address - Street 1:560 1ST AVE
Practice Address - Street 2:RR 607
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239493207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1680T1Medicare PIN