Healthcare Provider Details

I. General information

NPI: 1114280666
Provider Name (Legal Business Name): MRS. FRAN S BAMBARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 1ST AVE
NEW YORK NY
10010-4004
US

IV. Provider business mailing address

100 CARLSBAD CT
HOLMDEL NJ
07733-2548
US

V. Phone/Fax

Practice location:
  • Phone: 917-256-4259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: