Individual provider · NPI-1

Kenneth Edward Bloom, M.D.

Dermatology · Bronx, NY

NPI number1477536068
StatusActive
Last updated in NPPESAug 22, 2019

Details

NPI
1477536068
Entity type
Individual (NPI-1)
Name
Kenneth Edward Bloom
Credential
M.D.
Sex
Male
Sole proprietor
No
Enumeration date
Nov 28, 2005
Last updated
Aug 22, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207N00000X Dermatology169466NYYes

Practice location

1455 West Ave
Bronx, NY 10462-7304

Phone 718-239-1500 · Fax 212-765-3210

Mailing address

200 Central Park S Apt 107
New York, NY 10019-1449

Phone 212-262-2500 · Fax 212-765-3210

Other practice locations

2432 Grand Concourse Rm 501
Bronx, NY 10458-5204

Phone 718-537-5000 · Fax 212-765-3210

291 E 149th St
Bronx, NY 10451-5601

Phone 718-671-1000 · Fax 212-765-3210

2100 Bartow Ave Ste 211
Bronx, NY 10475-4614

Phone 718-671-1000 · Fax 212-765-3210

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