Bloomfield Health Pavilion LLC

Primary specialty

Community Health Nurse PractitionerTaxonomy code 363LC1500X

Legal business name

BLOOMFIELD HEALTH PAVILION LLC

Practice address

86 Bloomfield Ave
1St Floor & Basement
Newark, NJ 07104-1905

Phone

(973) 230-3631

Fax

(973) 230-3474

NPI assigned

Jul 15, 2006

Last updated

Sep 11, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Rostislav Vilshteyn

Title

Ceo

Phone

(718) 813-4556

Specialties & licenses 11

Addresses

Locations

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1598781973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 BLOOMFIELD AVE",
            "address_2": "1ST FLOOR & BASEMENT",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071041905",
            "telephone_number": "973-230-3631",
            "fax_number": "973-230-3474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 BLOOMFIELD AVE",
            "address_2": "1ST FLOOR & BASEMENT",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071041905",
            "telephone_number": "973-230-3631",
            "fax_number": "973-230-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMFIELD HEALTH PAVILION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "VILSHTEYN",
        "authorized_official_first_name": "ROSTISLAV",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-813-4556",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "NJ",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "051A267",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "051A267",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "NJ",
            "license": "051A267",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NJ",
            "license": "051A267",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NJ",
            "license": "051A267",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NJ",
            "license": "051A267",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NJ",
            "license": "051A267",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "NJ",
            "license": "051A267",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nikolas Anthony Bletnitsky
• Sergey Blintsovskiy, MD
• Samantha Block, MD
• Bloomfield Ave Dental Spec, LLC
• Bloomfield Ave Dental, LLC
• Bloomfield Hospital Physicians, P.a.
• Blue Aid Home Care LLC
• Blue Medical Diagnostics East
• Blue Star Medical Transport
• BMG Newark LLC (Blue Star Urgent Care & Walk-in Medical Center)

• Community Health Nurse Practitioner in Newark, NJ
• Providers in Newark, NJ by specialty
• Community Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.