Provider Demographics
NPI:1164446746
Name:NORTH RIDGE INTERNAL MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:NORTH RIDGE INTERNAL MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-491-2140
Mailing Address - Street 1:5601 N DIXIE HWY
Mailing Address - Street 2:SUITE 412
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4148
Mailing Address - Country:US
Mailing Address - Phone:954-491-2140
Mailing Address - Fax:954-491-9640
Practice Address - Street 1:5601 N DIXIE HWY
Practice Address - Street 2:SUITE 412
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4148
Practice Address - Country:US
Practice Address - Phone:954-491-2140
Practice Address - Fax:954-491-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38843Medicare ID - Type Unspecified