1588933907 NPI number — MICHELLE WESTON-BLOOM MSED, BCBA

Table of content: MICHELLE WESTON-BLOOM MSED, BCBA (NPI 1588933907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588933907 NPI number — MICHELLE WESTON-BLOOM MSED, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTON-BLOOM
Provider First Name:
MICHELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSED, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588933907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 SYCAMORE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY POINT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11778-8641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-404-0838
Provider Business Mailing Address Fax Number:
631-849-5731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 SYCAMORE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11778-8641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-404-0838
Provider Business Practice Location Address Fax Number:
631-849-5731
Provider Enumeration Date:
12/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com