| Doctor Name: | DR. JENNIFER BLITZ |
| NPI Number: | 1013031483 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 013716 |
| Business Practice Address: | 111 Smithtown Byp Suite 121 Hauppauge, NY - 117882524 |
| Business Phone Number: | 6317428523 |
| Business Fax Number: | 6319790438 |
| Mailing Address: | 1 Norma Ln, KINGS PARK |
| State: | NY |
| Postal Code: | 117544520 |
| Phone Number: | 6317428523 |
| Fax Number: | 6319790438 |
| NPI Enumeration Date: | 03/19/2007 |
| NPI Last Update Date: | 01/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 013716 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |