Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 25MA05990000 | NJ |
NPI | 1164594784 |
---|---|
Provider Name | Dr. Tamir Bloom |
First Address | Cedar Knolls, NJ 07927-2109 |
Second Address | Cedar Knolls, NJ 07927-2109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 06/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0160245 | (05) | NJ |