Provider Demographics
NPI:1700902541
Name:BLITZ, RANDI (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:
Last Name:BLITZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:RANDI
Other - Middle Name:
Other - Last Name:BLITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:213 WARWICK LN
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1127
Mailing Address - Country:US
Mailing Address - Phone:201-242-6816
Mailing Address - Fax:201-567-4740
Practice Address - Street 1:188 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-6455
Practice Address - Country:US
Practice Address - Phone:201-983-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6231186OtherUNITEDHEALTHCARE
NYP2515999OtherOXFORD
NYX4V901OtherBCBS
NY134184144-01Other1199
NYX4V901OtherBCBS