Provider Demographics
NPI:1871568634
Name:BEMBENEK, GARRETT S (DPM)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:S
Last Name:BEMBENEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-1354
Mailing Address - Country:US
Mailing Address - Phone:570-339-5024
Mailing Address - Fax:570-339-2953
Practice Address - Street 1:50 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-1354
Practice Address - Country:US
Practice Address - Phone:570-339-5024
Practice Address - Fax:570-339-2953
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001931L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABE21905Medicare ID - Type UnspecifiedLEGACY BILLING IDENTIFIER