Healthcare Provider Details

I. General information

NPI: 1376090423
Provider Name (Legal Business Name): BLOOMFIELD HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 GLENWOOD AVENUE
BLOOMFIELD NJ
07003
US

IV. Provider business mailing address

PO BOX 1468
BLOOMFIELD NJ
07003-1468
US

V. Phone/Fax

Practice location:
  • Phone: 862-220-4261
  • Fax: 973-748-2222
Mailing address:
  • Phone: 862-220-4261
  • Fax: 973-748-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SONIA LASMIN
Title or Position: DIRECTOR
Credential:
Phone: 347-683-3008