Healthcare Provider Details

I. General information

NPI: 1528078664
Provider Name (Legal Business Name): EDNA BLUMSTEIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HEMPSTEAD AVE SUITE I
LYNBROOK NY
11563-1614
US

IV. Provider business mailing address

50 HEMPSTEAD AVE SUITE I
LYNBROOK NY
11563-1614
US

V. Phone/Fax

Practice location:
  • Phone: 516-996-6507
  • Fax:
Mailing address:
  • Phone: 516-996-6507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number012331
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number012331
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: