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General NPI Number Information
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NPI Number | 1003008343
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Entity Type | Organization
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Legal Business Name | BRUCE & MARILYN VINOKUR FOOT CARE GROUP LLC
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 1211 W MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06708-3106
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Country | US
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Telephone | 203-755-2050
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Fax | 203-755-0131
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Provider Business Mailing Address
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Address Line | 1211 WEST MAIN STREET
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City | WATERBURY
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State | CT
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Zip | 06708-2762
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Country | US
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Telephone | 203-755-2050
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Fax | 203-755-0131
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. MARILYN M. VINOKUR
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Credential | D.P.M.
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Telephone | 203-755-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 00214
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License Number State | CT
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