Emanuel M. Dicicco-Bloom, MD

Primary specialty

Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X

License

25MA05478100 Issued in NJ

Practice address

89 French St Ste 2300
New Brunswick, NJ 08901-1935

Phone

(732) 235-7875

Fax

(732) 235-6620

NPI assigned

Oct 4, 2006

Last updated

Jul 23, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Rutgers Health-RWJ Scleroderma Program

  • Allergy & Immunology (Internal Medicine) Physician
  • New Brunswick, NJ
  • NPI 1679655781
  Medicare reassignment NPD
• Rutgers Health-RWJ Primary Medicine Group

  • Internal Medicine Physician
  • New Brunswick, NJ
  • NPI 1992887012
  NPD
• Rutgers Health-RWJ Scleroderma Program

  • Pediatric Adolescent Medicine Physician
  • New Brunswick, NJ
  • NPI 1023055738
  NPD
• Rutgers Health-RWJ Scleroderma Program

  • Psychiatry Physician
  • Piscataway, NJ
  • NPI 1033207378
  NPD
• Rutgers Health-RWJ Scleroderma Program

  • Pediatric Nephrology Physician
  • New Brunswick, NJ
  • NPI 1457469348
  NPD
• Rutgers Health-RWJ Scleroderma Program

  • Maternal & Fetal Medicine Physician
  • Somerville, NJ
  • NPI 1750453346
  NPD
• Rutgers Health-RWJ Scleroderma Program

  • Radiation Oncology Physician
  • New Brunswick, NJ
  • NPI 1942249909
  NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1578658720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 WEST GILBERT ST",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "07701",
            "telephone_number": "732-212-0051",
            "fax_number": "732-212-0713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 FRENCH ST STE 2300",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011935",
            "telephone_number": "732-235-7875",
            "fax_number": "732-235-6620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Robert Wood Johnson Pl",
            "address_purpose": "LOCATION",
            "city": "New Brunswick",
            "state": "NJ",
            "postal_code": "089011928",
            "country_code": "US",
            "telephone_number": "732-828-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICICCO-BLOOM",
        "first_name": "EMANUEL",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "NJ",
            "license": "MA54781",
            "primary": false
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "NJ",
            "license": "25MA05478100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0870706",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dialysis Clinic Inc (DCI George Street)
• Dialysis Clinic Inc.
• Deanna Marina Diaz, DO
• Susan Darlyne Dibs, M.D.
• Karissa Danise Enriquez Dichoso, APN
• Abigail Bonnie Dickson
• Marisa Beatrice Digiulio, DO
• Dignified Care Services LLC
• Dignity Home Care LLC
• Estela P Dimes, APN

• Pediatric Neurodevelopmental Disabilities Physician in New Brunswick, NJ
• Providers in New Brunswick, NJ by specialty
• Pediatric Neurodevelopmental Disabilities Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; 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.