Provider Demographics
NPI:1548469406
Name:BLOOMSTEIN, LARRY
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:BLOOMSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 CRANBURY RD STE 10
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5419
Mailing Address - Country:US
Mailing Address - Phone:732-238-8800
Mailing Address - Fax:732-238-8246
Practice Address - Street 1:557 CRANBURY RD STE 10
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5419
Practice Address - Country:US
Practice Address - Phone:732-238-8800
Practice Address - Fax:732-238-8246
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08156400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01162442OtherRAILROAD MEDICARE
NJ803603YJ50Medicare PIN
P01162442OtherRAILROAD MEDICARE