Active NPI
Marc Richard Bernbach, DPM
- Podiatrist
- Waterbury, CT
National Provider Identifier
1538149463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 000447
- Practice address
- 171 Grandview Ave
Suite 104
Waterbury, CT 06708-2517 - Phone
- (203) 753-2048
- Fax
- (203) 753-5891
- NPI assigned
- Jan 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 000447 | CT | Primary |
Addresses
Primary practice location
171 Grandview Ave
Suite 104
Waterbury, CT 06708-2517
Mailing address
171 Grandview Ave
Suite 104
Waterbury, CT 06708-2517
Phone (203) 753-2048
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 409031 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000447 | CT | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194825600000",
"number": "1538149463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "171 GRANDVIEW AVE",
"address_2": "SUITE 104",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067082517",
"telephone_number": "203-753-2048",
"fax_number": "203-753-5891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "171 GRANDVIEW AVE",
"address_2": "SUITE 104",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067082517",
"telephone_number": "203-753-2048",
"fax_number": "203-753-5891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERNBACH",
"first_name": "MARC",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-18",
"last_updated": "2007-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "CT",
"license": "000447",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "409031",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.