Basic Information
| Provider Information | |||||||||
| NPI: | 1700882610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BILBOOL | ||||||||
| FirstName: | NORMA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 FIREMENS MEMORIAL DR | ||||||||
| Address2: | 115 | ||||||||
| City: | POMONA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109703553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007508616 | ||||||||
| FaxNumber: | 8453628474 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 ROUTE 59 | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | SUFFERN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109015204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007508616 | ||||||||
| FaxNumber: | 8453628474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 045759 | CT | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 174400000X | 10712 | MT | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 10712 | 01 | MT | MONTANA STATE LICENSE | OTHER | BB4990594 | 01 | MT | DEA NUMBER | OTHER | 000084498 | 01 | MT | UNKNOWN | OTHER | 250000407 | 01 | CT | MEDICARE | OTHER |