Provider Demographics
NPI:1154781334
Name:DR. EDEN FROMBERG, DO
Entity type:Organization
Organization Name:DR. EDEN FROMBERG, DO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:FROMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-343-8053
Mailing Address - Street 1:166 5TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5909
Mailing Address - Country:US
Mailing Address - Phone:212-343-8053
Mailing Address - Fax:212-343-8055
Practice Address - Street 1:197 GRAND ST
Practice Address - Street 2:3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3790
Practice Address - Country:US
Practice Address - Phone:212-343-8053
Practice Address - Fax:212-343-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty