Provider Demographics
NPI:1679769939
Name:RICHARD B BLOOMENSTEIN MD FACS PA
Entity Type:Organization
Organization Name:RICHARD B BLOOMENSTEIN MD FACS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLOOMENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-569-2244
Mailing Address - Street 1:245 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2465
Mailing Address - Country:US
Mailing Address - Phone:201-569-2244
Mailing Address - Fax:201-569-1628
Practice Address - Street 1:245 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2465
Practice Address - Country:US
Practice Address - Phone:201-569-2244
Practice Address - Fax:201-569-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ458681Medicare UPIN
NJF03840Medicare UPIN