Mitchell Bloom, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

045016 Issued in NY

Practice address

880 5TH Ave
Suite 1-G
New York, NY 10021-4951

Phone

(212) 327-2623

NPI assigned

Sep 9, 2014

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mitchell J. Bloom, D.M.D., P.C.

  • Dental Clinic/Center
  • New York, NY
  • NPI 1366513194
  NPD (past) Authorized official

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

{
    "created_epoch": "1410220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410220800000",
    "number": "1467853408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 5TH AVE",
            "address_2": "SUITE 1-G",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214951",
            "telephone_number": "212-327-2623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 5TH AVE",
            "address_2": "SUITE 1-G",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214951",
            "telephone_number": "212-327-2623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "MITCHELL",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-09",
        "last_updated": "2014-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "045016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Bloom
• Lawrence Michael Bloom, M.D.
• Matthew Ira Bloom, D.D.S.
• Michael Lloyd Bloom, D.D.S.
• Michelle Jordana Bloom, L.C.S.W.
• Mollie Bloom
• Naomi Bloom
• Norman David Bloom, M.D.
• Patricia Bloom, MD
• Rachel Bloom, PSYD

• Periodontics in New York, NY
• Providers in New York, NY by specialty
• Periodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2014; 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.