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General NPI Number Information
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NPI Number | 1679828560
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Entity Type | Organization
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Legal Business Name | BLITZ PODIATRY, PC
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 34 S BROADWAY SUITE 504
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4400
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Country | US
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Telephone | 914-289-2590
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Fax |
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Provider Business Mailing Address
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Address Line | 34 S BROADWAY SUITE 504
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4400
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Country | US
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Telephone | 914-289-2590
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TARA BLITZ-HERBEL
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Credential | DPM
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Telephone | 914-289-2590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 006385
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License Number State | NY
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