1447210703 NPI number — RONDA BLOOM MD

Table of content: RONDA BLOOM MD (NPI 1447210703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447210703 NPI number — RONDA BLOOM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOOM
Provider First Name:
RONDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447210703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3003 NEW HYDE PARK RD
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-1214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-327-0850
Provider Business Mailing Address Fax Number:
516-327-0920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 NEW HYDE PARK RD
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-327-0850
Provider Business Practice Location Address Fax Number:
516-327-0920
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  218242-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2535845 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3630031 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1069863 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1233S1 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2399673 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8524456 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA72967 . This is a "MDNY" identifier . This identifiers is of the category "OTHER".




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