Healthcare Provider Details

I. General information

NPI: 1679689343
Provider Name (Legal Business Name): AMY R BLOOMGARDEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 EAST 30TH ST
NEW YORK NY
10016
US

IV. Provider business mailing address

338 EAST 30TH ST
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-683-0090
  • Fax: 212-689-3699
Mailing address:
  • Phone: 212-683-0090
  • Fax: 212-689-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number224606
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: