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General NPI Number Information
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NPI Number | 1376210740
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Entity Type | Individual
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Provider Name | DANIELLE C BLOOM
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Gender | Female
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 1018 BROAD ST STE 1
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-2884
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Country | US
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Telephone | 973-429-0890
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Fax |
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Provider Business Mailing Address
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Address Line | 614 LENOX AVE
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City | WESTFIELD
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State | NJ
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Zip | 07090-2161
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Country | US
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Telephone | 917-318-1075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01094000
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License Number State | NJ
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