Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 158788 | NY |
NPI | 1003841446 |
---|---|
Provider Name | Alan F. Bloom |
First Address | Pittsford, NY 14534 |
Second Address | Pittsford, NY 14534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 04/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180010335 | MEDICARE (01) | NY |
C49665 | (02) | NY |