Healthcare Provider Details

I. General information

NPI: 1396839486
Provider Name (Legal Business Name): ALAN BLOOMBERG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1694 CENTRAL AVE
ALBANY NY
12205
US

IV. Provider business mailing address

1694 CENTRAL AVE
ALBANY NY
12205
US

V. Phone/Fax

Practice location:
  • Phone: 518-869-3884
  • Fax: 518-869-6030
Mailing address:
  • Phone: 518-869-3884
  • Fax: 518-869-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ERICKA H. JENSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 518-869-3884