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General NPI Number Information
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NPI Number | 1003085762
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Entity Type | Organization
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Legal Business Name | SANFORD BLOOMBERG MD PC
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 16 CENTER STREET ROOM 226
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City | NORTHAMPTON
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State | MA
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Zip | 01060
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Country | US
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Telephone | 413-584-1402
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Fax | 413-585-1565
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Provider Business Mailing Address
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Address Line | 112 WASHINGTON AVENUE
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City | NORTHAMPTON
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State | MA
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Zip | 01060
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Country | US
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Telephone | 413-584-1402
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Fax | 413-585-1565
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Authorized Official
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Title or Position | PC PRESIDENT
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Name | DR. SANFORD BLOOMBERG
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Credential |
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Telephone | 413-584-1402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 31443
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License Number State | MA
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