Healthcare Provider Details

I. General information

NPI: 1912442625
Provider Name (Legal Business Name): TAYLOR LEIGH BLOOM NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

85 E 10TH ST APT F
NEW YORK NY
10003-5408
US

V. Phone/Fax

Practice location:
  • Phone: 917-593-1254
  • Fax:
Mailing address:
  • Phone: 917-593-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number350415
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: