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General NPI Number Information
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NPI Number | 1104050095
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Entity Type | Individual
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Provider Name | BRIAN KEITH BLITZ P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 40 ROBERT PITT DR
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City | MONSEY
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State | NY
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Zip | 10952-3333
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Country | US
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Telephone | 201-753-8989
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Fax |
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Provider Business Mailing Address
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Address Line | 40 ROBERT PITT DR
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City | MONSEY
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State | NY
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Zip | 10952-3333
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Country | US
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Telephone | 201-753-8989
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00001400
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License Number State | NJ
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