Provider Demographics
NPI:1932782232
Name:BLUMENFRUCHT, CHERYL (NP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:BLUMENFRUCHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 EASTCHESTER RD APT 2A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2187
Mailing Address - Country:US
Mailing Address - Phone:917-286-7620
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4427
Practice Address - Country:US
Practice Address - Phone:973-777-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403446363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health