MEDICARE: DR. JESSICA BLOOMGARDEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	ME116270	FL

General Provider Information

NPI Number	:	1013158427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA BLOOMGARDEN MD

Provider Business Mailing Address
First Line	:	PO BOX 22239
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-0001
Country	:	US
Telephone Number	:	702-899-0595
Fax Number	:	702-977-1496

Provider Business Practice Location Address
First Line	:	1516 E LAS OLAS BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2346
Country	:	US
Telephone Number	:	872-231-3162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	11/07/2025

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