Provider Demographics
NPI:1023590726
Name:LIFSCHUTZ, BLAIRE S
Entity type:Individual
Prefix:
First Name:BLAIRE
Middle Name:S
Last Name:LIFSCHUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PROSPECT AVE APT 12W
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1651
Mailing Address - Country:US
Mailing Address - Phone:561-859-7502
Mailing Address - Fax:
Practice Address - Street 1:210 N CENTRAL AVE STE 340A
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1952
Practice Address - Country:US
Practice Address - Phone:914-428-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009457224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant