Healthcare Provider Details

I. General information

NPI: 1508789819
Provider Name (Legal Business Name): SARA B BLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHLOMA D KATZ

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 15TH AVE APT 6D
BROOKLYN NY
11219-3728
US

IV. Provider business mailing address

5100 15TH AVE APT 6D
BROOKLYN NY
11219-3728
US

V. Phone/Fax

Practice location:
  • Phone: 917-821-0100
  • Fax:
Mailing address:
  • Phone: 917-821-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: