Healthcare Provider Details

I. General information

NPI: 1356255509
Provider Name (Legal Business Name): ELDERBLOOM WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 MAYER DR
SUFFERN NY
10901-3728
US

IV. Provider business mailing address

57 MAYER DR
SUFFERN NY
10901-3728
US

V. Phone/Fax

Practice location:
  • Phone: 954-366-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHAIM UHR
Title or Position: CEO
Credential:
Phone: 954-366-2700