Healthcare Provider Details

I. General information

NPI: 1528170016
Provider Name (Legal Business Name): BLUMA S PRICE R.P.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1822
US

IV. Provider business mailing address

585 SCHENECTADY AVE MANAGED CARE DEPT. - 6TH FLOOR, BLUMBERG BLDG
BROOKLYN NY
11203-1809
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5421
  • Fax: 718-604-5527
Mailing address:
  • Phone: 718-604-5469
  • Fax: 718-604-5527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003283
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: