Provider Demographics
NPI:1891786703
Name:GOLDBLATT, ROBERT B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:GOLDBLATT
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:NORTHERN BLVD
Mailing Address - Street 2:ACADEMIC HEALTH CARE CENTER NY INSTITUTE OF TECHNOLOGY
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-8000
Mailing Address - Country:US
Mailing Address - Phone:516-686-1300
Mailing Address - Fax:516-686-7890
Practice Address - Street 1:NORTHERN BLVD
Practice Address - Street 2:ACADEMIC HEALTH CARE CENTER NY INSTITUTE OF TECHNOLOGY
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-8000
Practice Address - Country:US
Practice Address - Phone:516-686-1300
Practice Address - Fax:516-686-7890
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0090881103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1821048612OtherGROUP NPI NUMBER
NY1891786703OtherNPI NUMBER
NYV572405883Medicare PIN
NY1891786703OtherNPI NUMBER