Provider Demographics
NPI:1477739514
Name:DEBORAH RUIZ BLENK, M.D.,P.C.
Entity type:Organization
Organization Name:DEBORAH RUIZ BLENK, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:RUIZ
Authorized Official - Last Name:BLENK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-520-4080
Mailing Address - Street 1:2900 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE110
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1404
Mailing Address - Country:US
Mailing Address - Phone:516-520-4080
Mailing Address - Fax:516-520-4081
Practice Address - Street 1:2900 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE110
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1404
Practice Address - Country:US
Practice Address - Phone:516-520-4080
Practice Address - Fax:516-520-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153529207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00832320Medicaid
NY00832320Medicaid