Provider Demographics
NPI:1447528740
Name:BRUCE AND MARILYN VINOKUR FOOT CARE GROUP LLC
Entity type:Organization
Organization Name:BRUCE AND MARILYN VINOKUR FOOT CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VINOKUR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-888-6668
Mailing Address - Street 1:17 WESTERMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3330
Mailing Address - Country:US
Mailing Address - Phone:203-888-6668
Mailing Address - Fax:203-888-6489
Practice Address - Street 1:17 WESTERMAN AVENUE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3330
Practice Address - Country:US
Practice Address - Phone:203-888-6668
Practice Address - Fax:203-888-6489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000214213ES0103X
000214332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4700850002Medicare NSC