Provider Demographics
NPI:1659994440
Name:BLUMBERG, GREGG DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:DAVID
Last Name:BLUMBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:260 1ST ST APT D14
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2373
Mailing Address - Country:US
Mailing Address - Phone:845-558-9822
Mailing Address - Fax:
Practice Address - Street 1:NYU LISOM 222 STATION PLAZA NORTH
Practice Address - Street 2:SUITE 510
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3893
Practice Address - Country:US
Practice Address - Phone:516-663-8794
Practice Address - Fax:516-663-8796
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY16599944402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology