Healthcare Provider Details

I. General information

NPI: 1831594589
Provider Name (Legal Business Name): BLOOM NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 E 85TH ST APT 36B
NEW YORK NY
10028-2191
US

IV. Provider business mailing address

185 E 85TH ST APT 36B
NEW YORK NY
10028-2191
US

V. Phone/Fax

Practice location:
  • Phone: 917-690-1146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PRINGLE
Title or Position: CO-OWNER
Credential: MS ED
Phone: 917-690-1146