Healthcare Provider Details

I. General information

NPI: 1578961611
Provider Name (Legal Business Name): KRISTIE PLOCINSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BARGER ST.
CORTLANDT MANOR NY
10567
US

IV. Provider business mailing address

4 BARGER ST
CORTLANDT MANOR NY
10567-1037
US

V. Phone/Fax

Practice location:
  • Phone: 914-523-3948
  • Fax:
Mailing address:
  • Phone: 914-523-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number692489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: