Provider Demographics
NPI:1710169156
Name:BLITMAN, SIMEON T (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIMEON
Middle Name:T
Last Name:BLITMAN
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 1:1535 45TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1629
Mailing Address - Country:US
Mailing Address - Phone:718-972-1100
Mailing Address - Fax:718-972-1177
Practice Address - Street 1:1535 45TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1629
Practice Address - Country:US
Practice Address - Phone:718-972-1100
Practice Address - Fax:718-972-1177
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist