Provider Demographics
NPI:1902097207
Name:MOSENKIS, JUDITH BLUM (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:BLUM
Last Name:MOSENKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:BATYA
Other - Last Name:BLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3690 ORANGE PL
Mailing Address - Street 2:SUITE 430
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4464
Mailing Address - Country:US
Mailing Address - Phone:216-464-5330
Mailing Address - Fax:216-464-5332
Practice Address - Street 1:3690 ORANGE PL
Practice Address - Street 2:SUITE 430
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4464
Practice Address - Country:US
Practice Address - Phone:216-464-5330
Practice Address - Fax:216-464-5332
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH890532084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H88738Medicare UPIN