Organization
JESSICA BLOOMGARDEN MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA BLOOMGARDEN MD (PRESIDENT)
(646) 265-9264
Entity
Organization
Contact information
Practice address
4399 N NOB HILL RD, SUNRISE, FL 33351-5813
(954) 746-1505
Mailing address
109 MONTCLAIRE DR, WESTON, FL 33326-3587
(646) 265-9264
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
ME116270
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013158427
—
FL
Enumeration date
12/19/2017
Last updated
12/19/2017
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