Healthcare Provider Details

I. General information

NPI: 1093083982
Provider Name (Legal Business Name): JAY NEIL PLOTKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N LAKEMONT AVE
WINTER PARK FL
32792-3273
US

IV. Provider business mailing address

200 N LAKEMONT AVE
WINTER PARK FL
32792-3273
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7495
  • Fax:
Mailing address:
  • Phone: 407-646-7495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number16356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: