Healthcare Provider Details

I. General information

NPI: 1508945148
Provider Name (Legal Business Name): ROBERT L PLUMMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 E MOSHOLU PKWY S
BRONX NY
10458-1206
US

IV. Provider business mailing address

176 E MOSHOLU PKWY S
BRONX NY
10458-1206
US

V. Phone/Fax

Practice location:
  • Phone: 718-367-6100
  • Fax: 718-733-4020
Mailing address:
  • Phone: 718-367-6100
  • Fax: 718-733-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number158669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: