Provider Demographics
NPI:1457354128
Name:PINKER, BRUCE STEVEN (DPM)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:STEVEN
Last Name:PINKER
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 1:427 BROADWAY
Mailing Address - Street 2:STE 2
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1743
Mailing Address - Country:US
Mailing Address - Phone:845-794-7741
Mailing Address - Fax:
Practice Address - Street 1:427 BROADWAY
Practice Address - Street 2:STE 2
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1743
Practice Address - Country:US
Practice Address - Phone:845-794-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005741213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV03100Medicare UPIN