Provider Demographics
NPI:1528041829
Name:BLITSHTEYN, SVETLANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:BLITSHTEYN
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 1:55 VISCOUNT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1766
Mailing Address - Country:US
Mailing Address - Phone:716-531-4598
Mailing Address - Fax:716-478-6917
Practice Address - Street 1:835 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2322
Practice Address - Country:US
Practice Address - Phone:716-531-4598
Practice Address - Fax:716-478-6917
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2464202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000530048002OtherBLUE CROSS BLUE SHIELD OF WESTERN NEW YORK
NY00028420702OtherUNIVERA
NY0515063OtherINDEPENDENT HEALTH
NY02946041Medicaid
FLI22987Medicare UPIN