Provider Demographics
NPI:1023195237
Name:BLEEKER, DAVID PAUL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:BLEEKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-1723
Mailing Address - Country:US
Mailing Address - Phone:973-754-4200
Mailing Address - Fax:973-754-4201
Practice Address - Street 1:21 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1723
Practice Address - Country:US
Practice Address - Phone:973-754-4200
Practice Address - Fax:973-754-4201
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148814207R00000X
NJ25MA04224000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C59840Medicare UPIN
417024Medicare ID - Type Unspecified