MEDICARE: DEBRA KORNBLUH

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	225X00000X	Occupational Therapist	017889	NY

General Provider Information

NPI Number	:	1932440716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA KORNBLUH

Provider Business Mailing Address
First Line	:	1147 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4608
Country	:	US
Telephone Number	:	718-207-7735
Fax Number	:

Provider Business Practice Location Address
First Line	:	1147 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4608
Country	:	US
Telephone Number	:	718-207-7735
Fax Number	:

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

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	03/04/2013

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Directions to “ DEBRA KORNBLUH ” Practice Location

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