Healthcare Provider Details

I. General information

NPI: 1346915378
Provider Name (Legal Business Name): JACOB SAMUEL BLITSTEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date: 04/10/2022
Reactivation Date: 07/28/2022

III. Provider practice location address

987 QUEEN ST APT 3509
HONOLULU HI
96814-3327
US

IV. Provider business mailing address

987 QUEEN ST APT 3509
HONOLULU HI
96814-3327
US

V. Phone/Fax

Practice location:
  • Phone: 847-363-9065
  • Fax:
Mailing address:
  • Phone: 847-363-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1346915378
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: