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General NPI Number Information
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NPI Number | 1558877068
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Entity Type | Organization
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Legal Business Name | JESSICA BLOOMGARDEN MD PA
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 4399 N NOB HILL RD
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City | SUNRISE
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State | FL
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Zip | 33351-5813
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Country | US
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Telephone | 954-746-1505
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Fax |
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Provider Business Mailing Address
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Address Line | 109 MONTCLAIRE DR
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City | WESTON
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State | FL
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Zip | 33326-3587
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Country | US
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Telephone | 646-265-9264
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA BLOOMGARDEN
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Credential | MD
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Telephone | 646-265-9264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME116270
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License Number State | FL
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