Basic Information
| Provider Information | |||||||||
| NPI: | 1902874670 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BLOOM | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5501 OLD YORK ROAD, MOSS 4TH FLOOR, SLEY BUILDING | ||||||||
| Address2: | EINSTEIN NEPHROLOGY ASSOCIATES | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154566970 | ||||||||
| FaxNumber: | 2154567154 | ||||||||
| Practice Location | |||||||||
| Address1: | 5501 OLD YORK ROAD, MOSS 4TH FLOOR, SLEY BUILDING | ||||||||
| Address2: | EINSTEIN NEPHROLOGY ASSOCIATES | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154566970 | ||||||||
| FaxNumber: | 2154567154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | MD035775E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 001177795 | 05 | RI | MEDICAID |