Amanda Eve Immerblum, MS, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

26NJ15046300 Issued in NJ

Practice address

256 Broad St
Bloomfield, NJ 07003-2766

Phone

(973) 743-4450

NPI assigned

Apr 3, 2024

Last updated

Apr 3, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1023860061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 SMITH LN",
            "city": "SOMERS",
            "state": "NY",
            "postal_code": "105891922",
            "telephone_number": "914-844-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 BROAD ST",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070032766",
            "telephone_number": "973-743-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMMERBLUM",
        "first_name": "AMANDA",
        "middle_name": "EVE",
        "credential": "MS, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-03",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "353866",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ15046300",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "713221",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NR24627100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ayman M Ibrahim, D.O.
• Demiana Ibrahim
• Liza Ibrahim, LPC
• Icare Pharmacy
• Immedicenter Bloomfield
• Wanda E Ince
• Anthony C Ingenito, MD
• Julio Iniguez, LMFT
• Introspection, Mind,Body&Spirit Center
• Irie Dental Associates LLC

• Family Nurse Practitioner in Bloomfield, NJ
• Providers in Bloomfield, NJ by specialty
• Family Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.