Provider Demographics
NPI:1821704008
Name:BLUMSTEIN, PENINA
Entity Type:Individual
Prefix:
First Name:PENINA
Middle Name:
Last Name:BLUMSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 NEILSON ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5097
Mailing Address - Country:US
Mailing Address - Phone:516-405-9585
Mailing Address - Fax:
Practice Address - Street 1:1030 NEILSON ST APT 1E
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5097
Practice Address - Country:US
Practice Address - Phone:516-405-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant