Provider Demographics
NPI:1164594784
Name:BLOOM, TAMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMIR
Middle Name:
Last Name:BLOOM
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 1:218 RIDGEDALE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-2109
Mailing Address - Country:US
Mailing Address - Phone:973-538-7700
Mailing Address - Fax:973-538-9478
Practice Address - Street 1:218 RIDGEDALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2109
Practice Address - Country:US
Practice Address - Phone:973-538-7700
Practice Address - Fax:973-538-9478
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05990000207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0160245Medicaid