Provider Demographics
NPI:1811908940
Name:BLUMBERG, STEPHEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:BLUMBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 PELHAM PKWY S
Mailing Address - Street 2:BUILDING 6, ROM 1B25
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1138
Mailing Address - Country:US
Mailing Address - Phone:718-918-5826
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:BUILDING 6, ROM 1B25
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY219432-1207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF37655Medicare UPIN