Provider Demographics
NPI:1568422947
Name:BLOOMGARDEN, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BLOOMGARDEN
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 1:259 HEATHCOTE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4523
Mailing Address - Country:US
Mailing Address - Phone:914-723-8100
Mailing Address - Fax:914-428-8167
Practice Address - Street 1:259 HEATHCOTE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4523
Practice Address - Country:US
Practice Address - Phone:914-723-8100
Practice Address - Fax:914-428-8167
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138123207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17880Medicare UPIN
NY68A551Medicare ID - Type Unspecified