Provider Demographics
NPI:1154441707
Name:BLUMBERGER, KRISTEN G (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:G
Last Name:BLUMBERGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10165-0006
Mailing Address - Country:US
Mailing Address - Phone:212-697-1094
Mailing Address - Fax:212-682-0838
Practice Address - Street 1:60 E 42ND ST
Practice Address - Street 2:1521
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10165-0006
Practice Address - Country:US
Practice Address - Phone:212-697-1094
Practice Address - Fax:212-682-0838
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist