Provider Demographics
NPI:1063095867
Name:BLAU, ALIZA M
Entity type:Individual
Prefix:MS
First Name:ALIZA
Middle Name:M
Last Name:BLAU
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 1:14124 73RD TER
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2307
Mailing Address - Country:US
Mailing Address - Phone:718-551-4307
Mailing Address - Fax:
Practice Address - Street 1:14124 73RD TER
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2307
Practice Address - Country:US
Practice Address - Phone:718-551-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst