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General NPI Number Information
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NPI Number | 1578479853
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Entity Type | Organization
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Legal Business Name | BLOOM HEALTHCARE HUDSON VALLEY
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Dates
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Enumeration Date | 08/19/2026
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Last Update Date | 08/19/2026
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Provider Practice Location Address
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Address Line | 1133 ROUTE 55 STE A
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City | LAGRANGEVILLE
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State | NY
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Zip | 12540-5052
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Country | US
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Telephone | 845-319-9179
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Fax |
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Provider Business Mailing Address
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Address Line | 3 ANTLER CT
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City | HOPEWELL JUNCTION
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State | NY
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Zip | 12533-3545
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Country | US
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Telephone | 914-799-2023
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Fax |
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Authorized Official
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Title or Position | PROVIDER & OWNER
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Name | MRS. KELLY ROLISON
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Credential | FNP-C, MSN
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Telephone | 914-799-2023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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