Bloomfield Health Pavilion LLC
Nurse Practitioner, Community Health in Newark, NJ. Organization (NPI-2).
NPI number1598781973
StatusActive
Last updated in NPPESSep 11, 2025
Details
- NPI
- 1598781973
- Entity type
- Organization (NPI-2)
- Legal business name
- Bloomfield Health Pavilion LLC
- Organization subpart
- No
- Enumeration date
- Jul 15, 2006
- Last updated
- Sep 11, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LC1500X | Nurse Practitioner, Community Health | – | NJ | Yes |
| 103TA0400X | Psychologist, Addiction (Substance Use Disorder) | 051A267 | NJ | |
| 103TA0700X | Psychologist, Adult Development & Aging | 051a267 | NJ | |
| 103TB0200X | Psychologist, Cognitive & Behavioral | 051a267 | NJ | |
| 103TC1900X | Psychologist, Counseling | 051A267 | NJ | |
| 103TC2200X | Psychologist, Clinical Child & Adolescent | 051A267 | NJ | |
| 103T00000X | Psychologist | 051A267 | NJ | |
| 103TP2701X | Psychologist, Group Psychotherapy | 051A267 | NJ | |
| 103TR0400X | Psychologist, Rehabilitation | 051a267 | NJ | |
| 363L00000X | Nurse Practitioner | – | NJ | |
| 363LP2300X | Nurse Practitioner, Primary Care | – | NJ |
Practice location
86 Bloomfield Ave1st Floor & Basement
Newark, NJ 07104-1905
Phone 973-230-3631 · Fax 973-230-3474
Mailing address
86 Bloomfield Ave1st Floor & Basement
Newark, NJ 07104-1905
Phone 973-230-3631 · Fax 973-230-3474
Authorized official
Rostislav Vilshteyn
Ceo
7188134556
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