Provider Demographics
NPI:1730474883
Name:MARGOLIS, BLIMA DEVORAH (MS ED)
Entity type:Individual
Prefix:MRS
First Name:BLIMA
Middle Name:DEVORAH
Last Name:MARGOLIS
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N CREST PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2989
Mailing Address - Country:US
Mailing Address - Phone:732-905-0556
Mailing Address - Fax:
Practice Address - Street 1:125 N CREST PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2989
Practice Address - Country:US
Practice Address - Phone:732-905-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00393247174H00000X
NJ00393248174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator