MEDICARE: DR. SANDER JAY KORNBLITH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS003630L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	034250	OTHER		HIGHMARK

General Provider Information

NPI Number	:	1467546705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDER JAY KORNBLITH PH.D.

Provider Business Mailing Address
First Line	:	700 BLAW AVE STE 201
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-3216
Country	:	US
Telephone Number	:	412-559-4364
Fax Number	:	412-968-0527

Provider Business Practice Location Address
First Line	:	700 BLAW AVE STE 201
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-3216
Country	:	US
Telephone Number	:	412-967-0610
Fax Number	:	412-968-0527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/18/2024

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