Bloom, Tracy A.

Bloom, Tracy A. is an sole proprietor health care provider with primary practice located at 62 Pawnee Dr , Commack NY 11725-4222. She recently has only one registered license in Nursing Service Providers / Registered Nurse, which is considered as her primary health care specialty. Bloom, Tracy A. can be contacted via phone (631) 864-6402.

Contact Information

Primary practice address
62 Pawnee Dr Commack NY 11725-4222
Phone: (631) 864-6402
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 509923-1 New York

Profile Details

NPI number 1982747853
LBN Legal business name Bloom, Tracy A.
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 14th, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982747853 NPPES
New York MEDICAID 02365382

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