Provider Demographics
NPI:1063580256
Name:BLENK, DEBORAH RUIZ (MD; LMSW)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:RUIZ
Last Name:BLENK
Suffix:
Gender:F
Credentials:MD; LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 DIVISION AVE STE 215E
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2947
Mailing Address - Country:US
Mailing Address - Phone:917-881-3301
Mailing Address - Fax:
Practice Address - Street 1:2255 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3499
Practice Address - Country:US
Practice Address - Phone:212-375-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153529207W00000X
NY112673-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY153529OtherNYS LICENSE
NY00832320Medicaid
NY00832320Medicaid
NY19D811Medicare ID - Type Unspecified