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General NPI Number Information
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NPI Number | 1780902585
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Entity Type | Individual
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Provider Name | BRADLEY STEPHEN BLOOM M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 1125 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10128-1243
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Country | US
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Telephone | 212-876-3319
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Fax | 212-423-0840
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Provider Business Mailing Address
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Address Line | 1125 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10128-1243
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Country | US
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Telephone | 212-876-3319
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Fax | 212-423-0840
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MA09583800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 262147
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License Number State | NY
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