Provider Demographics
NPI:1669638409
Name:BLOOM, RACHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 W 26TH ST
Mailing Address - Street 2:APT. 22A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6840
Mailing Address - Country:US
Mailing Address - Phone:516-702-8920
Mailing Address - Fax:212-454-1186
Practice Address - Street 1:100 W 26TH ST
Practice Address - Street 2:APT. 22A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6840
Practice Address - Country:US
Practice Address - Phone:516-702-8920
Practice Address - Fax:212-454-1186
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY249825207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology