MEDICARE: NEW BLOOM DERMATOLOGY, PLLC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1982271987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BLOOM DERMATOLOGY, PLLC

Provider Business Mailing Address
First Line	:	670 GREENWICH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-6340
Country	:	US
Telephone Number	:	212-207-0078
Fax Number	:	212-480-7375

Provider Business Practice Location Address
First Line	:	670 GREENWICH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-6340
Country	:	US
Telephone Number	:	212-207-0078
Fax Number	:	646-480-7375

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. ERIN KIL
Credential	:	MD
Telephone Number	:	212-207-0078

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	11/04/2021

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