Healthcare Provider Details

I. General information

NPI: 1396815957
Provider Name (Legal Business Name): EDEN G FROMBERG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 SNYDER RD
GHENT NY
12075-2616
US

IV. Provider business mailing address

259 SNYDER RD
GHENT NY
12075-2616
US

V. Phone/Fax

Practice location:
  • Phone: 212-343-8053
  • Fax: 212-343-8055
Mailing address:
  • Phone: 212-343-8053
  • Fax: 212-343-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number200492-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: