MEDICARE: GREEN, STUART & MARINOW, HARRY & BONFILIO, NICHOLAS & FEIWELL, LAWRENC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	W13148A	OTHER		PTAN
3	GR0066741	OTHER	CA	MEDI-CAL GROUP NUMBER
4	ZZZ53510Z	OTHER	CA	BLUE SHIELD PIN#
5	W13148B	OTHER		OTHER PTAN

General Provider Information

NPI Number	:	1467524652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN, STUART & MARINOW, HARRY & BONFILIO, NICHOLAS & FEIWELL, LAWRENC

Provider Business Mailing Address
First Line	:	1040 ELM AVE
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3264
Country	:	US
Telephone Number	:	562-591-4444
Fax Number	:	562-436-7350

Provider Business Practice Location Address
First Line	:	1040 ELM AVE
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3264
Country	:	US
Telephone Number	:	562-591-4444
Fax Number	:	562-436-7350

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. DUKE AHN
Credential	:	M.D.
Telephone Number	:	562-430-3561

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	05/16/2012

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Directions to “GREEN, STUART & MARINOW, HARRY & BONFILIO, NICHOLAS & FEIWELL, LAWRENC ” Practice Location

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