Provider Demographics
NPI:1063676872
Name:DAVID P. BLEEKER MD
Entity Type:Organization
Organization Name:DAVID P. BLEEKER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BLEEKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-487-1711
Mailing Address - Street 1:211 ESSEX ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3231
Mailing Address - Country:US
Mailing Address - Phone:201-487-1711
Mailing Address - Fax:201-487-3377
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:SUITE 401
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3231
Practice Address - Country:US
Practice Address - Phone:201-487-1711
Practice Address - Fax:201-487-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC59840Medicare UPIN