Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 099606-1 | NY |
NPI | 1003041377 |
---|---|
Provider Name | Stanley Bloom |
First Address | Lake Worth, FL 33449 |
Second Address | Old Forge, NY 13420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2009 |
Last Update Date | 15/05/2009 |