Provider Demographics
NPI:1700892635
Name:BLOOMGARDEN, ZACHARY T (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:T
Last Name:BLOOMGARDEN
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 1:35 E 85TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0954
Mailing Address - Country:US
Mailing Address - Phone:212-879-5933
Mailing Address - Fax:212-861-7429
Practice Address - Street 1:35 E 85TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0954
Practice Address - Country:US
Practice Address - Phone:212-879-5933
Practice Address - Fax:212-861-7429
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125739174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00235089Medicaid
NY125739OtherNY STATE LICENSE NUMBER
NYB12267Medicare UPIN
NY00235089Medicaid