Individual
KENNETH EDWARD BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1455 WEST AVE, BRONX, NY 10462-7304
(718) 239-1500
(212) 765-3210
Mailing address
200 CENTRAL PARK S APT 107, NEW YORK, NY 10019-1449
(212) 262-2500
(212) 765-3210
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
169466
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04134401
—
NY
Enumeration date
11/28/2005
Last updated
08/22/2019
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