Provider Demographics
NPI:1164471561
Name:VINOKUR, MARILYN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:M
Last Name:VINOKUR
Suffix:
Gender:F
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:2006-05-10
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT000215213ES0131X
CT000215213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061060793008OtherCIGNA
CT508832OtherAETNA
CT760793OtherCONNECTICARE
CTNHS335OtherOXFORD
NYPBW42OtherEMPIRE BC
CT061060793OtherTAX ID
CT061060793OtherUNITED HEALTHCARE
CT004068821(GROUP)Medicaid
CTOR0932OtherACS HEALTHNET
CT030000215CT01OtherBLUECROSS/BLUESHIELD
CT29528OtherWELLCARE
CT061060793008OtherCIGNA
CT004068821(GROUP)Medicaid
CT030000215CT01OtherBLUECROSS/BLUESHIELD