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General NPI Number Information
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NPI Number | 1245976950
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Entity Type | Organization
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Legal Business Name | BLOOM ANESTHESIA
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 393 BLOOMFIELD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3741
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Country | US
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Telephone | 973-746-1500
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Fax | 973-746-0937
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Provider Business Mailing Address
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Address Line | 393 BLOOMFIELD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3741
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Country | US
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Telephone | 973-746-1500
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | MICHAEL KOTSATOS
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Credential |
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Telephone | 917-497-4182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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