MEDICARE: DR. DENNIS A BLOOMFIELD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	099669	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OS240	OTHER	NY	OXFORD
2	0057365	OTHER		GHI

General Provider Information

NPI Number	:	1689667446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS A BLOOMFIELD MD

Provider Business Mailing Address
First Line	:	1102 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3622
Country	:	US
Telephone Number	:	718-442-5230
Fax Number	:	718-816-4927

Provider Business Practice Location Address
First Line	:	1102 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3622
Country	:	US
Telephone Number	:	718-442-5230
Fax Number	:	718-816-4927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	04/16/2008

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