Healthcare Provider Details

I. General information

NPI: 1417007261
Provider Name (Legal Business Name): BARRY FOMBERSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 233RD ST
BRONX NY
10466-2604
US

IV. Provider business mailing address

600 EAST 233RD STREET MONTEFIORE MEDICAL CENTER - NORTH DIVISION
BRONX NY
10466-2604
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9168
  • Fax: 718-920-9036
Mailing address:
  • Phone: 718-920-9168
  • Fax: 718-920-9036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number131884
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: