Provider Demographics
NPI:1487603346
Name:VINOKUR, BRUCE M (DPM)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:VINOKUR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3106
Mailing Address - Country:US
Mailing Address - Phone:203-755-2050
Mailing Address - Fax:203-755-0131
Practice Address - Street 1:1211 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3106
Practice Address - Country:US
Practice Address - Phone:203-755-2050
Practice Address - Fax:203-755-0131
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT000214213ES0131X
CT000214213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004068821Medicaid
CT061060793003OtherCIGNA
CTNHS348OtherOXFORD
CTORO931OtherACS HEALTHNET
CT061060793OtherUNITED HEALTH CARE
CT030000214CT01OtherBLUE CROSS BLUE SHIELD
CT760794OtherCONNECTICARE
CT508844OtherAETNA
CTPBW42OtherEMPIRE BLUECROSS
CTT22139Medicare UPIN
CT4700850001Medicare NSC
CT480000354Medicare PIN
CTORO931OtherACS HEALTHNET