Healthcare Provider Details

I. General information

NPI: 1134050412
Provider Name (Legal Business Name): BLOSSOM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5702 17TH AVE
BROOKLYN NY
11204-1841
US

IV. Provider business mailing address

5702 17TH AVE
BROOKLYN NY
11204-1841
US

V. Phone/Fax

Practice location:
  • Phone: 718-354-8376
  • Fax:
Mailing address:
  • Phone: 718-354-8376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH KLEIN
Title or Position: OWNER / MANAGING MEMBER
Credential:
Phone: 718-354-8376