MEDICARE: ALYSE R BELLOMO 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	207RG0100X	Gastroenterology Physician	183197-1	NY
2	207RG0100X	Gastroenterology Physician	25MA08394400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5269090	OTHER	NY	AETNA
2	107014	OTHER	NY	MVP
3	000405355001	OTHER	NY	BLUE SHIELD
4	39J23	OTHER	NY	EMPIRE BC/BS
5	127303	OTHER	NY	WELLCARE
6	040426006461	OTHER	NY	FIDELIS
7	100008772	OTHER	NY	RR/MCR
8	27303	OTHER	NY	GHI/HMO
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	2505278	OTHER	NY	GHI
11	10002444	OTHER	NY	CDPHP
12	1415851130011	OTHER	NY	CIGNA

General Provider Information

NPI Number	:	1700890837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSE R BELLOMO MD

Provider Business Mailing Address
First Line	:	466 OLD HOOK ROAD
Second Line	:	SUITE 1
City	:	EMERSON
State	:	NJ
Zip	:	07630-1368
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	466 OLD HOOK ROAD
Second Line	:	SUITE 1
City	:	EMERSON
State	:	NJ
Zip	:	07630-1368
Country	:	US
Telephone Number	:	518-272-0234
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	12/13/2012

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Directions to “ ALYSE R BELLOMO MD” Practice Location

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