Healthcare Provider Details
I. General information
NPI: 1881199115
Provider Name (Legal Business Name): PLAGIOCARELLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/28/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
200 S ORANGE AVE STE 250
LIVINGSTON NJ
07039-5817
US
IV. Provider business mailing address
200 S ORANGE AVE STE 250
LIVINGSTON NJ
07039-5817
US
V. Phone/Fax
- Phone: 973-758-8195
- Fax: 973-251-9039
- Phone: 973-758-8195
- Fax: 973-251-9039
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 222Z00000X |
| Taxonomy | Orthotist |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2251P0200X |
| Taxonomy | Pediatric Physical Therapist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
FRANK
CIMINELLO
Title or Position: MD
Credential:
Phone: 917-584-0578