Provider Demographics
NPI:1417132234
Name:MARVIN GINSBERG, D.P.M.
Entity Type:Organization
Organization Name:MARVIN GINSBERG, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GINSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-853-7282
Mailing Address - Street 1:111 EAST AVE
Mailing Address - Street 2:SUITE 317
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5014
Mailing Address - Country:US
Mailing Address - Phone:203-853-7282
Mailing Address - Fax:203-853-3050
Practice Address - Street 1:111 EAST AVE
Practice Address - Street 2:SUITE 317
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5014
Practice Address - Country:US
Practice Address - Phone:203-853-7282
Practice Address - Fax:203-853-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000070213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4223180001Medicare NSC
CTT22360Medicare UPIN