Provider Demographics
NPI:1295536415
Name:BLANK, TOVAH
Entity type:Individual
Prefix:
First Name:TOVAH
Middle Name:
Last Name:BLANK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 ARBUCKLE AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1304
Mailing Address - Country:US
Mailing Address - Phone:516-592-0682
Mailing Address - Fax:
Practice Address - Street 1:374 ARBUCKLE AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1304
Practice Address - Country:US
Practice Address - Phone:516-592-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program