Provider Demographics
NPI:1982969473
Name:BLUMENTHAL, LEORA F (MSED)
Entity type:Individual
Prefix:MRS
First Name:LEORA
Middle Name:F
Last Name:BLUMENTHAL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 SURREY PL
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1434
Mailing Address - Country:US
Mailing Address - Phone:718-705-8662
Mailing Address - Fax:
Practice Address - Street 1:8103 SURREY PL
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1434
Practice Address - Country:US
Practice Address - Phone:718-705-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY524811111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist