MEDICARE: DR. KRISTEN G BLUMBERGER DMD

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	122300000X	Dentist	049321	NY

General Provider Information

NPI Number	:	1154441707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN G BLUMBERGER DMD

Provider Business Mailing Address
First Line	:	60 E 42ND ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10165-0006
Country	:	US
Telephone Number	:	212-697-1094
Fax Number	:	212-682-0838

Provider Business Practice Location Address
First Line	:	60 E 42ND ST
Second Line	:	1521
City	:	NEW YORK
State	:	NY
Zip	:	10165-0006
Country	:	US
Telephone Number	:	212-697-1094
Fax Number	:	212-682-0838

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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