Provider Demographics
NPI:1053415778
Name:BELL, BURT LAWRENCE (DPM)
Entity type:Individual
Prefix:DR
First Name:BURT
Middle Name:LAWRENCE
Last Name:BELL
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 1:3065 BRIGHTON 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6407
Mailing Address - Country:US
Mailing Address - Phone:718-332-2722
Mailing Address - Fax:718-332-2722
Practice Address - Street 1:3065 BRIGHTON 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6407
Practice Address - Country:US
Practice Address - Phone:718-332-2722
Practice Address - Fax:718-332-2722
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002592213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY127732OtherUNITED HEALTHCARE
NY3C5148OtherHEALTHNET
NYN002592-A18OtherHEALTHFIRST
NYN002592-B18OtherHEALTHFIRST
NYN002592OtherHIP
NY06441OtherGHI-MEDICARE
NY7020206OtherCIGNA
NYP245678OtherOXFORD
NY00414833Medicaid
NY4937180001Medicare NSC
NY06441OtherGHI-MEDICARE
NYP29901Medicare PIN
NYP245678OtherOXFORD