Healthcare Provider Details

I. General information

NPI: 1871757914
Provider Name (Legal Business Name): HEATHER JILL PLESKOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39765 DATE ST # 102
MURRIETA CA
92563-2005
US

IV. Provider business mailing address

6930 WILLIAMS RD SUITE 3700
NIAGARA FALLS NY
14304-3096
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-4665
  • Fax: 951-894-5178
Mailing address:
  • Phone: 716-298-3541
  • Fax: 716-298-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number246011-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number246011-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: