Provider Demographics
NPI:1457593139
Name:SVETLANA BLITSHTEYN MD PC
Entity Type:Organization
Organization Name:SVETLANA BLITSHTEYN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLITSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-531-4598
Mailing Address - Street 1:100 COLLEGE PKWY
Mailing Address - Street 2:STE150
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6800
Mailing Address - Country:US
Mailing Address - Phone:716-531-4598
Mailing Address - Fax:716-478-6917
Practice Address - Street 1:100 COLLEGE PKWY
Practice Address - Street 2:STE150
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6800
Practice Address - Country:US
Practice Address - Phone:716-531-4598
Practice Address - Fax:716-478-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100000224Medicare PIN