Healthcare Provider Details

I. General information

NPI: 1346565520
Provider Name (Legal Business Name): EILEEN K PLOTKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN KISILIS M.D.

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LIBERTY SQ
NEW BRITAIN CT
06051-2637
US

IV. Provider business mailing address

30 WATERCHASE DR
ROCKY HILL CT
06067-2110
US

V. Phone/Fax

Practice location:
  • Phone: 860-229-9688
  • Fax: 860-229-5498
Mailing address:
  • Phone: 860-257-4131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52227
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number52227
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number52227
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: