Provider Demographics
NPI:1164597290
Name:BLOOM, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6254 97TH PL
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1346
Mailing Address - Country:US
Mailing Address - Phone:718-595-1166
Mailing Address - Fax:718-595-1167
Practice Address - Street 1:6254 97TH PL
Practice Address - Street 2:SUITE 2B
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1346
Practice Address - Country:US
Practice Address - Phone:718-595-1166
Practice Address - Fax:718-595-1167
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4061374OtherAETNA US HEALTHCARE
NY487Y22OtherEMPIRE HEALTH CHOICE
NY73546OtherVYTRA
NY000083377007OtherUNITEDHEALTHCARE
NY4C1906OtherHEALTHNET
NY6628678003OtherCIGNA
NYDP093OtherOXFORD
NY010167049NY01OtherANTHEM
NY167049OtherHIP
NY01824886Medicaid
NY000083377009OtherUNITEDHEALTHCARE
NY010167049NY02OtherANTHEM
NY2697963OtherGHI
NY74747OtherVYTRA
NY487Y21OtherEMPIRE HEALTHCHOICE
NYBB0635930OtherDEA
NY74747OtherVYTRA