Provider Demographics
NPI:1679754246
Name:BLUMBERG, PHILLIP (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:BLUMBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2413
Mailing Address - Country:US
Mailing Address - Phone:212-496-1300
Mailing Address - Fax:
Practice Address - Street 1:135 CENTRAL PARK W
Practice Address - Street 2:SUITE 1N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2413
Practice Address - Country:US
Practice Address - Phone:212-496-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical