Healthcare Provider Details

I. General information

NPI: 1093394181
Provider Name (Legal Business Name): APOLLO MEDICAL GROUP OF BLOOMFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 BROAD ST STE 100
BLOOMFIELD NJ
07003-3039
US

IV. Provider business mailing address

PO BOX 4366
SPRINGFIELD IL
62708-4366
US

V. Phone/Fax

Practice location:
  • Phone: 201-402-2050
  • Fax: 201-402-2034
Mailing address:
  • Phone: 941-360-1566
  • Fax: 941-358-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: AYMAN ELFAR
Title or Position: MEMBER/MANAGER
Credential: MD
Phone: 941-360-1566