Healthcare Provider Details

I. General information

NPI: 1447210703
Provider Name (Legal Business Name): RONDA BLOOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 GREAT NECK RD STE 200
GREAT NECK NY
11021-4308
US

IV. Provider business mailing address

3003 NEW HYDE PARK RD 201
NEW HYDE PARK NY
11042-1214
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-6747
  • Fax: 516-482-4851
Mailing address:
  • Phone: 516-327-0850
  • Fax: 516-327-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number218242-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: