Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 151886 | NY |
Y | 2080P0205X | Pediatric Endocrinologist | 151886 | NY |
NPI | 1255674149 |
---|---|
Provider Name | Dr. Denise Laura Blumberg |
First Address | Roslyn, NY 11576-2015 |
Second Address | Roslyn, NY 11576-2015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2013 |
Last Update Date | 29/03/2013 |