Healthcare Provider Details

I. General information

NPI: 1821188806
Provider Name (Legal Business Name): ISRAEL R PLASNER ODPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 ROUTE 22 EAST
GREEN BROOK NJ
08812
US

IV. Provider business mailing address

255 ROUTE 22 EAST
GREEN BROOK NJ
08812
US

V. Phone/Fax

Practice location:
  • Phone: 732-752-6222
  • Fax: 732-752-2030
Mailing address:
  • Phone: 732-752-6222
  • Fax: 732-752-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00341600
License Number StateNJ

VIII. Authorized Official

Name: DR. ISRAEL R PLASNER
Title or Position: OPTOMETRIC PHYSICIAN
Credential:
Phone: 732-752-6222