Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | N-004707 | NY |
N | 222Z00000X | Podiatrist | N-004707 | NY |
Y | 213ES0131X | Foot Surgery | N-004707 | NY |
NPI | 1225035835 |
---|---|
Provider Name | Dr. Wayne Brian Bloom |
First Address | Yorktown Heights, NY 10598-4108 |
Second Address | Yorktown Heights, NY 10598-4108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2005 |
Last Update Date | 07/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480013301 | MEDICARE RAILROAD (01) | NY |
480015388 | MEDICARE RAILROAD (01) | NY |
U10277 | (02) | NY |