Healthcare Provider Details

I. General information

NPI: 1023590726
Provider Name (Legal Business Name): BLAIRE S LIFSCHUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N CENTRAL AVE STE 340A
HARTSDALE NY
10530-1952
US

IV. Provider business mailing address

65 PROSPECT AVE APT 12W
HEWLETT NY
11557-1651
US

V. Phone/Fax

Practice location:
  • Phone: 914-428-5151
  • Fax:
Mailing address:
  • Phone: 561-859-7502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number009457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: