Provider Demographics
NPI:1972676393
Name:WEINBLATT, ALAN S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:S
Last Name:WEINBLATT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25517 NORTHERN BLVD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1469
Mailing Address - Country:US
Mailing Address - Phone:718-279-4808
Mailing Address - Fax:
Practice Address - Street 1:25517 NORTHERN BLVD
Practice Address - Street 2:SUITE B1
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1469
Practice Address - Country:US
Practice Address - Phone:718-279-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012440103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical