Provider Demographics
NPI:1881643054
Name:BAMBERGER, ASRAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:ASRAEL
Middle Name:J
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 1:20 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3766
Mailing Address - Country:US
Mailing Address - Phone:718-622-4100
Mailing Address - Fax:718-857-8415
Practice Address - Street 1:20 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3766
Practice Address - Country:US
Practice Address - Phone:718-622-4100
Practice Address - Fax:718-857-8415
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1133011207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00205472Medicaid
NY00205472Medicaid
NYB14631Medicare UPIN