Individual
DR. FREDRIC BOMBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
99 FIELDSTONE DR, HARTSDALE, NY 10530-1564
(914) 428-2120
Mailing address
99 FIELDSTONE DR, HARTSDALE, NY 10530-1564
(914) 428-2120
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
106826
NY
208000000X
Pediatrics Physician
Primary
106826
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00187682
—
NY
01
—
0124825
AETNA HMO
NY
01
—
132625705
POMCO
NM
01
—
132625705
UNITED HEALTHCARE
NY
01
—
14733
HEALTHSOURCE
NY
01
—
1C7501
HEALTH NET
NY
01
—
5238573
AETNA PPO
NY
01
—
6301220003
CIGNA
NY
01
—
712981
EMPIRE BCBS
NY
01
—
WP235
OXFORD
NY
Enumeration date
01/06/2006
Last updated
01/28/2014
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