Healthcare Provider Details

I. General information

NPI: 1871568634
Provider Name (Legal Business Name): GARRETT S BEMBENEK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W 2ND ST
MOUNT CARMEL PA
17851-1354
US

IV. Provider business mailing address

50 W 2ND ST
MOUNT CARMEL PA
17851-1354
US

V. Phone/Fax

Practice location:
  • Phone: 570-339-5024
  • Fax: 570-339-2953
Mailing address:
  • Phone: 570-339-5024
  • Fax: 570-339-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC001931L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: