| Blossom Np In Psychiatry Health Pll | |
|
15-01 Broadway Ste 24 Fair Lawn NJ 07410-6006 | |
| (833) 325-6766 | |
| Not Available |
| Full Name | Blossom Np In Psychiatry Health Pll |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 15-01 Broadway Ste 24, Fair Lawn, New Jersey |
| Authorized Official Name and Position | Daliya Anoo Chandroth (OWNER) |
| Authorized Official Contact | 2012140400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Np In Psychiatry Health Pll 15-01 Broadway Ste 24 Fair Lawn NJ 07410-6006 Ph: (833) 325-6766 | Blossom Np In Psychiatry Health Pll 15-01 Broadway Ste 24 Fair Lawn NJ 07410-6006 Ph: (833) 325-6766 |
| NPI Number | 1417643842 |
|---|---|
| Provider Enumeration Date | 04/18/2023 |
| Last Update Date | 04/18/2023 |
| Certification Date | 04/17/2023 |
| Medicare PECOS PAC ID | 6406208933 |
|---|---|
| Medicare Enrollment ID | O20240119001633 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417643842 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Daliya A Chandroth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730738428 PECOS PAC ID: 2769714567 Enrollment ID: I20191127001167 |
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