Provider Demographics
NPI:1205066701
Name:BLITMAN SPEECH PATHOLOGY SERVICES, P.C.
Entity type:Organization
Organization Name:BLITMAN SPEECH PATHOLOGY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-972-1100
Mailing Address - Street 1:1535 45TH ST
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty