Healthcare Provider Details

I. General information

NPI: 1881372357
Provider Name (Legal Business Name): ZACHARY ELIAS BLOOM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 PARK AVE STE B
FREEHOLD NJ
07728-2590
US

IV. Provider business mailing address

597 PARK AVE STE B
FREEHOLD NJ
07728-2590
US

V. Phone/Fax

Practice location:
  • Phone: 732-294-2540
  • Fax:
Mailing address:
  • Phone: 732-294-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB12856400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25MB12856400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: