Provider Demographics
NPI:1740375047
Name:BLOOM, ADAM HARRY (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:HARRY
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:825 E GATE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2124
Mailing Address - Country:US
Mailing Address - Phone:516-804-5200
Mailing Address - Fax:
Practice Address - Street 1:1700 EAST JERICHO TURNPIKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-462-2020
Practice Address - Fax:631-462-2227
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214394207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY214394OtherSTATE LICENSE NUMBER
NY214394OtherSTATE LICENSE NUMBER
NYBB7743758OtherDEA NUMBER
NY214394OtherSTATE LICENSE NUMBER
NYH72316Medicare UPIN