Provider Demographics
NPI:1043360613
Name:BLMT
Entity type:Organization
Organization Name:BLMT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:201-567-8888
Mailing Address - Street 1:215 UNION ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4259
Mailing Address - Country:US
Mailing Address - Phone:201-567-8888
Mailing Address - Fax:201-567-8008
Practice Address - Street 1:215 UNION ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4259
Practice Address - Country:US
Practice Address - Phone:201-567-8888
Practice Address - Fax:201-567-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0081388Medicaid
NY02705677Medicaid
NJ5516330001Medicare NSC