Healthcare Provider Details

I. General information

NPI: 1780592451
Provider Name (Legal Business Name): MATTHEW MICHAEL BLOHM APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 MAIN ST
CHESTER NJ
07930-2669
US

IV. Provider business mailing address

530 MAIN ST
CHESTER NJ
07930-2669
US

V. Phone/Fax

Practice location:
  • Phone: 908-879-4300
  • Fax:
Mailing address:
  • Phone: 908-879-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15646900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: