Provider Demographics
NPI:1750319174
Name:BAMBERGER, PHILIP DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DAVID
Last Name:BAMBERGER
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 1:28-06 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3913
Mailing Address - Country:US
Mailing Address - Phone:201-475-8940
Mailing Address - Fax:201-475-8944
Practice Address - Street 1:28-06 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3913
Practice Address - Country:US
Practice Address - Phone:201-475-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA148058207L00000X
NJ25MA04440100207L00000X
FLME119009207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20F331Medicare PIN