Healthcare Provider Details

I. General information

NPI: 1861047193
Provider Name (Legal Business Name): BFPS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2019
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TOWN PL STE 110
BRYN MAWR PA
19010-3420
US

IV. Provider business mailing address

2 TOWN PL STE 110
BRYN MAWR PA
19010-3420
US

V. Phone/Fax

Practice location:
  • Phone: 215-900-2806
  • Fax:
Mailing address:
  • Phone: 610-762-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON DAVID BLOOM
Title or Position: OWNER
Credential: MD
Phone: 215-900-2806