Healthcare Provider Details

I. General information

NPI: 1548800642
Provider Name (Legal Business Name): BLOOMER HEALTH PT, OT, SLP SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LIVINGSTON ST APT 12S
BROOKLYN NY
11201-5043
US

IV. Provider business mailing address

44 COURT ST STE 1217
BROOKLYN NY
11201-4410
US

V. Phone/Fax

Practice location:
  • Phone: 347-291-7591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MAYA SCHWARTZ
Title or Position: CEO/PROGRAM DIRECTOR
Credential: PT, DPT
Phone: 347-580-5016