MEDICARE: DR. NORMAN DAVID BLOOM M.D.

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	174400000X	Specialist	124014	NY

General Provider Information

NPI Number	:	1417909110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN DAVID BLOOM M.D.

Provider Business Mailing Address
First Line	:	61 IRVING PL
Second Line	:	LLB
City	:	NEW YORK
State	:	NY
Zip	:	10003-2324
Country	:	US
Telephone Number	:	212-505-6167
Fax Number	:	212-598-9181

Provider Business Practice Location Address
First Line	:	61 IRVING PL
Second Line	:	LLB
City	:	NEW YORK
State	:	NY
Zip	:	10003-2324
Country	:	US
Telephone Number	:	212-505-6167
Fax Number	:	212-598-9181

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. NORMAN DAVID BLOOM M.D.” Practice Location

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