Healthcare Provider Details

I. General information

NPI: 1720018948
Provider Name (Legal Business Name): PLAZA MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 VETERANS AVE SUITE 103
BROOKLYN NY
11234-5639
US

IV. Provider business mailing address

6410 VETERANS AVE SUITE 103
BROOKLYN NY
11234-5639
US

V. Phone/Fax

Practice location:
  • Phone: 718-209-6400
  • Fax: 718-209-6060
Mailing address:
  • Phone: 718-209-6400
  • Fax: 718-209-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number097922-1
License Number StateNY

VIII. Authorized Official

Name: DR. JOSE RAMON QUINONES JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-209-4455