MEDICARE: DR. HOWARD ERIC BLOOM D.D.S.

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	1223G0001X	General Practice Dentistry	038740	NY

General Provider Information

NPI Number	:	1750589644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD ERIC BLOOM D.D.S.

Provider Business Mailing Address
First Line	:	4211 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-3747
Country	:	US
Telephone Number	:	212-795-8070
Fax Number	:	212-795-8070

Provider Business Practice Location Address
First Line	:	4211 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-3747
Country	:	US
Telephone Number	:	212-795-8070
Fax Number	:	212-795-8070

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/08/2007

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