Provider Demographics
NPI:1437460540
Name:LONDON HEALING CENTER LLC.
Entity Type:Organization
Organization Name:LONDON HEALING CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:BA (HONS)
Authorized Official - Phone:718-236-2930
Mailing Address - Street 1:5314 18TH AVE
Mailing Address - Street 2:BROOKLYN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1522
Mailing Address - Country:US
Mailing Address - Phone:718-236-2930
Mailing Address - Fax:
Practice Address - Street 1:5314 18TH AVE
Practice Address - Street 2:BROOKLYN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1522
Practice Address - Country:US
Practice Address - Phone:718-236-2930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011452-1111N00000X
NYX008299111N00000X
NY004149171100000X
NY003728171100000X
NY003799171100000X
NY006834173C00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty