Provider Demographics
NPI:1922379486
Name:BOMBART, FELICE (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICE
Middle Name:
Last Name:BOMBART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FELICE
Other - Middle Name:
Other - Last Name:BOMBART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:46 BACON RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1503
Mailing Address - Country:US
Mailing Address - Phone:516-385-4980
Mailing Address - Fax:
Practice Address - Street 1:46 BACON RD
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1503
Practice Address - Country:US
Practice Address - Phone:516-385-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163527-1208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology