Healthcare Provider Details

I. General information

NPI: 1447528740
Provider Name (Legal Business Name): BRUCE AND MARILYN VINOKUR FOOT CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WESTERMAN AVENUE
SEYMOUR CT
06483-3330
US

IV. Provider business mailing address

17 WESTERMAN AVENUE
SEYMOUR CT
06483-3330
US

V. Phone/Fax

Practice location:
  • Phone: 203-888-6668
  • Fax: 203-888-6489
Mailing address:
  • Phone: 203-888-6668
  • Fax: 203-888-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000214
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000214
License Number State

VIII. Authorized Official

Name: DR. BRUCE M VINOKUR
Title or Position: PODIATRIST
Credential: DPM
Phone: 203-888-6668