Healthcare Provider Details

I. General information

NPI: 1932782232
Provider Name (Legal Business Name): CHERYL BLUMENFRUCHT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAIN AVE
PASSAIC NJ
07055-4427
US

IV. Provider business mailing address

110 MAIN AVE
PASSAIC NJ
07055-4427
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-7638
  • Fax: 973-777-9311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403446
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: