Provider Demographics
NPI:1760507024
Name:BLOOM, HOWARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:
Last Name:BLOOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 HUNTER AVE
Mailing Address - Street 2:APT 5B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5622
Mailing Address - Country:US
Mailing Address - Phone:914-366-4410
Mailing Address - Fax:914-366-4411
Practice Address - Street 1:13 - 15 NEPERAN ROAD
Practice Address - Street 2:DENTAL ACCUMEN
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3446
Practice Address - Country:US
Practice Address - Phone:914-337-5252
Practice Address - Fax:914-337-5426
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01573642Medicaid