Individual
MRS. BETH HEATHER BLOOM
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
15 N PINE ST, MASSAPEQUA, NY 11758-2455
(516) 804-6191
Mailing address
15 N PINE ST, MASSAPEQUA, NY 11758-2455
(516) 804-6191
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
865058
NY
Other
Enumeration date
03/23/2006
Last updated
07/08/2007
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