Healthcare Provider Details

I. General information

NPI: 1043360613
Provider Name (Legal Business Name): BLMT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 UNION ST
HACKENSACK NJ
07601-4259
US

IV. Provider business mailing address

215 UNION ST
HACKENSACK NJ
07601-4259
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-8888
  • Fax: 201-567-8008
Mailing address:
  • Phone: 201-567-8888
  • Fax: 201-567-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0081388
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier02705677
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: HENRY ORTIZ
Title or Position: MANAGER
Credential: CRT
Phone: 201-567-8888