Active NPI
Stanley Bloom, MD
- Urology Physician
- Old Forge, NY
National Provider Identifier
1003041377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 099606-1
- Practice address
- 138 Goodell Rd
Old Forge, NY 13420 - Phone
- (315) 369-2003
- NPI assigned
- May 15, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 099606-1 | NY | MD | Urology Physician |
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 099606-1 | NY | Primary |
Addresses
NPPES NPI RegistryPrimary practice location
138 Goodell Rd
Old Forge, NY 13420
Mailing address
10760 North Green Dr
Lake Worth, FL 33449
Phone (561) 432-2020
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 15, 2009.
{
"created_epoch": "1242345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242345600000",
"number": "1003041377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10760 NORTH GREEN DR",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "33449",
"telephone_number": "561-432-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 GOODELL RD",
"city": "OLD FORGE",
"state": "NY",
"postal_code": "13420",
"telephone_number": "315-369-2003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOM",
"first_name": "STANLEY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-15",
"last_updated": "2009-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "NY",
"license": "099606-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Old Forge, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.