Healthcare Provider Details

I. General information

NPI: 1528575180
Provider Name (Legal Business Name): BERNARD SWIERZBINSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 GULF DR
NEW PORT RICHEY FL
34652-4019
US

IV. Provider business mailing address

1767 MASSACHUSETTS AVE NE
SAINT PETERSBURG FL
33703-3327
US

V. Phone/Fax

Practice location:
  • Phone: 352-535-0295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberPOR240
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPOR240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: