Provider Demographics
NPI:1366767014
Name:ZACHARY T. BLOOMGARDEN MD PC
Entity type:Organization
Organization Name:ZACHARY T. BLOOMGARDEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BLOOMGARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-879-5933
Mailing Address - Street 1:35 EAST 85TH STREET
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 EAST 85TH STREET
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000529-1133V00000X
NY125739207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00411050Medicaid
NY00235089Medicaid
NY00411050Medicaid
NYB12267Medicare UPIN
NYC10771Medicare UPIN
NY00235089Medicaid
NY9312E1Medicare PIN