NPIMap

Organization Active NPI

Bloomfield Total Health Center

  • Acupuncturist
  • Bloomfield, NJ
National Provider Identifier
1639105380
Registry record updated Jan 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
Legal business name
BLOOMFIELD TOTAL HEALTH CENTER
Practice address
1129 Broad St
Bloomfield, NJ 07003-2918
Phone
(973) 338-3620
Fax
(973) 338-4849
NPI assigned
Jun 24, 2006
Last updated
Jan 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2018

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

Authorized official

Name
Dr. Michael M Credico, DCNPI 1437180817
Title
Owner
Phone
(973) 338-3620

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NS0005X
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

1129 Broad St
Bloomfield, NJ 07003-2918

Mailing address

1129 Broad St
Bloomfield, NJ 07003-2918
Phone (973) 338-3620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040903000802 NJ Part B Supplier - Clinic/Group Practice 1850387010 Receives reassigned benefits from 10 practitioners
Practice locations: Bloomfield, NJ
O20250715000758 NJ DME Supplier - Nurse Practitioner 1850387010 Practice locations: Bloomfield, NJ

National Provider Directory

National Provider Directory

Locations

1129 Broad St
Bloomfield, NJ 07003
Phone (973) 338-3620

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517184000000",
    "number": "1639105380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 BROAD ST",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070032918",
            "telephone_number": "973-338-3620",
            "fax_number": "973-338-4849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 BROAD ST",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070032918",
            "telephone_number": "973-338-3620",
            "fax_number": "973-338-4849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMFIELD TOTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2018-01-29",
        "status": "A",
        "authorized_official_last_name": "CREDICO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-338-3620",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.