Provider Demographics
NPI:1245491364
Name:BLATT-MITTELMAN, NAOMI GOLDA (DPM)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:GOLDA
Last Name:BLATT-MITTELMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14905 79TH AVE
Mailing Address - Street 2:APT 336
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3855
Mailing Address - Country:US
Mailing Address - Phone:917-744-4721
Mailing Address - Fax:
Practice Address - Street 1:103 N 8TH AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2921
Practice Address - Country:US
Practice Address - Phone:917-744-4721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00305900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist