MEDICARE: DR. EDUARDO PLANTILLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	121728	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669541355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARDO PLANTILLA MD

Provider Business Mailing Address
First Line	:	135 BEACH 141ST ST
Second Line	:
City	:	BELLE HARBOR
State	:	NY
Zip	:	11694-1227
Country	:	US
Telephone Number	:	718-945-5624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1366 E 32ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5418
Country	:	US
Telephone Number	:	718-253-5831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	12/27/2012

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