Individual
STANLEY BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
138 GOODELL RD, OLD FORGE, NY 13420
(315) 369-2003
Mailing address
10760 NORTH GREEN DR, LAKE WORTH, FL 33449
(561) 432-2020
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
099606-1
NY
Other
Enumeration date
05/15/2009
Last updated
05/15/2009
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