Provider Demographics
NPI:1881260586
Name:GREENBLATT, SAMUEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 WARREN ST APT 105
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2721
Mailing Address - Country:US
Mailing Address - Phone:201-280-3058
Mailing Address - Fax:
Practice Address - Street 1:137 E 36TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3528
Practice Address - Country:US
Practice Address - Phone:212-686-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty