Individual
MRS. ILENE BOMZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
75 TOLL DR, SOUTHAMPTON, PA 18966-3074
(215) 364-5608
Mailing address
75 TOLL DR, SOUTHAMPTON, PA 18966-3074
(215) 364-5608
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
443356246
PASSPORT
PA
Enumeration date
04/13/2017
Last updated
04/13/2017
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