Provider Demographics
NPI:1982788972
Name:BLITZ, NEAL M (DPM)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:M
Last Name:BLITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 56TH ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3607
Mailing Address - Country:US
Mailing Address - Phone:212-776-4250
Mailing Address - Fax:
Practice Address - Street 1:120 E 56TH ST
Practice Address - Street 2:SUITE 800
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3607
Practice Address - Country:US
Practice Address - Phone:212-776-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005575213ES0103X
CAE4423213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U96535Medicare UPIN
000E44230Medicare ID - Type Unspecified
CA000E44230Medicaid