Healthcare Provider Details

I. General information

NPI: 1063676872
Provider Name (Legal Business Name): DAVID P. BLEEKER MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ESSEX ST SUITE 401
HACKENSACK NJ
07601-3231
US

IV. Provider business mailing address

211 ESSEX ST SUITE 401
HACKENSACK NJ
07601-3231
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-1711
  • Fax: 201-487-3377
Mailing address:
  • Phone: 201-487-1711
  • Fax: 201-487-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA42240
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID PAUL BLEEKER
Title or Position: PRESIDENT
Credential: MD
Phone: 201-487-1711