Individual provider Active NPI

Blima Chopp-Mandelbaum, LMSW

  • Social Worker
  • Wantagh, NY
National Provider Identifier
1134439532
Registry record updated Oct 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
081023-1 Issued in NY
Practice address
3375 Park Ave
Wantagh, NY 11793-3733
Phone
(516) 781-1911
Fax
(516) 781-1173
NPI assigned
Oct 19, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 081023-1 NY Primary

Addresses

Primary practice location

3375 Park Ave
Wantagh, NY 11793-3733

Mailing address

3375 Park Avenue
Wantagh, NY 11783-0037
Phone (516) 781-1911

Other identifiers 1

IdentifierTypeStateIssuer
03003069MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
081023-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Nassau Guidance Center Inc. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287446400000",
    "number": "1134439532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3375 PARK AVENUE",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117830037",
            "telephone_number": "516-781-1911",
            "fax_number": "516-781-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3375 PARK AVE",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117933733",
            "telephone_number": "516-781-1911",
            "fax_number": "516-781-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOPP-MANDELBAUM",
        "first_name": "BLIMA",
        "name_prefix": "Ms.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-19",
        "last_updated": "2010-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "081023-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03003069",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wantagh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.