Provider Demographics
NPI:1396815957
Name:FROMBERG, EDEN G (DO)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:G
Last Name:FROMBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:NY
Mailing Address - Zip Code:12075-2616
Mailing Address - Country:US
Mailing Address - Phone:212-343-8053
Mailing Address - Fax:212-343-8055
Practice Address - Street 1:259 SNYDER RD
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:NY
Practice Address - Zip Code:12075-2616
Practice Address - Country:US
Practice Address - Phone:212-343-8053
Practice Address - Fax:212-343-8055
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200492-1207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
EF02628010Medicare UPIN
262801Medicare ID - Type Unspecified