Provider Demographics
NPI:1336431840
Name:BLITZ, MATTHEW J (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:BLITZ
Suffix:
Gender:M
Credentials:MD, MBA
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Mailing Address - Street 1:376 E MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8441
Mailing Address - Country:US
Mailing Address - Phone:631-396-7000
Mailing Address - Fax:631-396-7026
Practice Address - Street 1:376 E MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-396-7000
Practice Address - Fax:631-396-7026
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY273750-1207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine