Healthcare Provider Details

I. General information

NPI: 1811926983
Provider Name (Legal Business Name): PLANCHER ORTHOPAEDICS & SPORTS MEDICINE,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 RIVER RD SUITE 100
COS COB CT
06807-2152
US

IV. Provider business mailing address

1160 PARK AVE
NEW YORK NY
10128-1212
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-2003
  • Fax: 203-863-2025
Mailing address:
  • Phone: 212-876-5200
  • Fax: 212-876-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number030654
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number181664
License Number StateNY

VIII. Authorized Official

Name: DR. KEVIN DAVID PLANCHER
Title or Position: PHYSICIAN
Credential: MD
Phone: 203-863-2003