Healthcare Provider Details

I. General information

NPI: 1124338462
Provider Name (Legal Business Name): GENEVIEVE PRESSMAN C.PED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GENEVIEVE BONPENSER C.PED

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S EXECUTIVE DR SUITE 101
BROOKFIELD WI
53005-4216
US

IV. Provider business mailing address

888 WORCESTER ST SUITE 130
WELLESLEY MA
02482-3744
US

V. Phone/Fax

Practice location:
  • Phone: 414-535-8134
  • Fax: 888-662-0859
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: