| Doctor Name: | MS. ENID DENISE BLOOM |
| NPI Number: | 1376585570 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS RD CDN |
| License Number: | 001217 |
| Business Practice Address: | 179th Street And Linden Blvd St. Albans, NY - 11425 |
| Business Phone Number: | 7185261000 |
| Business Fax Number: | |
| Mailing Address: | 198 Wellington Rd S, GARDEN CITY |
| State: | NY |
| Postal Code: | 115305519 |
| Phone Number: | 5165640186 |
| Fax Number: | |
| NPI Enumeration Date: | 06/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | 001217 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |