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General NPI Number Information
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NPI Number | 1831594589
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Entity Type | Organization
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Legal Business Name | BLOOM NEW YORK
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 185 E 85TH ST APT 36B
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City | NEW YORK
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State | NY
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Zip | 10028-2191
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Country | US
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Telephone | 917-690-1146
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Fax |
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Provider Business Mailing Address
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Address Line | 185 E 85TH ST APT 36B
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City | NEW YORK
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State | NY
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Zip | 10028-2191
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JENNIFER PRINGLE
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Credential | MS ED
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Telephone | 917-690-1146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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