Matthew Ira Bloom, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

031778 Issued in NY

Practice address

123 Waverly PL
1B
New York, NY 10011-9147

Phone

(212) 460-0955

Fax

(212) 460-0956

NPI assigned

Feb 22, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255466843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 WAVERLY PL",
            "address_2": "1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100119147",
            "telephone_number": "212-460-0955",
            "fax_number": "212-460-0956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 WAVERLY PL",
            "address_2": "1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100119147",
            "telephone_number": "212-460-0955",
            "fax_number": "212-460-0956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "MATTHEW",
        "middle_name": "IRA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "031778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Bloom
• Julia Blake Bloom
• Julie Bloom
• Katherine Bloom
• Lawrence Michael Bloom, M.D.
• Michael Lloyd Bloom, D.D.S.
• Michelle Jordana Bloom, L.C.S.W.
• Mitchell Bloom, D.M.D.
• Mollie Bloom
• Naomi Bloom

• General Practice Dentistry in New York, NY
• Providers in New York, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.