Healthcare Provider Details

I. General information

NPI: 1760344212
Provider Name (Legal Business Name): THE BLOSSOM MINDS HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 BRIDGE ST
METUCHEN NJ
08840-2278
US

IV. Provider business mailing address

53 BRIDGE ST
METUCHEN NJ
08840-2278
US

V. Phone/Fax

Practice location:
  • Phone: 201-338-0305
  • Fax: 908-994-8961
Mailing address:
  • Phone: 201-338-0305
  • Fax: 908-994-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHIDIMA EMELE
Title or Position: OWNER
Credential: APN
Phone: 201-338-0305