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General NPI Number Information
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NPI Number | 1598781973
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Entity Type | Organization
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Legal Business Name | BLOOMFIELD HEALTH PAVILION LLC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 86 BLOOMFIELD AVE 1ST FLOOR & BASEMENT
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City | NEWARK
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State | NJ
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Zip | 07104-1905
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Country | US
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Telephone | 973-230-3631
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Fax | 973-230-3474
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Provider Business Mailing Address
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Address Line | 86 BLOOMFIELD AVE 1ST FLOOR & BASEMENT
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City | NEWARK
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State | NJ
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Zip | 07104-1905
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Country | US
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Telephone | 973-230-3631
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Fax | 973-230-3474
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Authorized Official
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Title or Position | CEO
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Name | MR. ROSTISLAV VILSHTEYN
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Credential |
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Telephone | 718-813-4556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 051A267
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | 051A267
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 051A267
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 051A267
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 051A267
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License Number State | NJ
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Taxonomy #6
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 051A267
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License Number State | NJ
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Taxonomy #7
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 051A267
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License Number State | NJ
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Taxonomy #8
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 051A267
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License Number State | NJ
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Taxonomy #9
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | NJ
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Taxonomy #10
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State | NJ
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Taxonomy #11
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number |
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License Number State | NJ
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