Provider Demographics
NPI:1679689343
Name:BLOOMGARDEN, AMY R (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:BLOOMGARDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 EAST 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-683-0090
Mailing Address - Fax:212-689-3699
Practice Address - Street 1:338 EAST 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-683-0090
Practice Address - Fax:212-689-3699
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224606207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0M1345OtherHNET
NY5224741003OtherCIGNA
NY568D61Medicare ID - Type Unspecified
H70992Medicare UPIN