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General NPI Number Information
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NPI Number | 1063580256
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Entity Type | Individual
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Provider Name | DEBORAH RUIZ BLENK MD; LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 2255 CENTRE AVE
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City | BELLMORE
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State | NY
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Zip | 11710-3499
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Country | US
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Telephone | 212-375-8606
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Fax |
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Provider Business Mailing Address
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Address Line | 64 DIVISION AVE STE 215E
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City | LEVITTOWN
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State | NY
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Zip | 11756-2947
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Country | US
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Telephone | 917-881-3301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 153529
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 112673-01
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License Number State | NY
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