Healthcare Provider Details

I. General information

NPI: 1750371241
Provider Name (Legal Business Name): LESTER N PLOSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 PENNSYLVANIA AVE
FREEPORT NY
11520-1328
US

IV. Provider business mailing address

241 PENNSYLVANIA AVE
FREEPORT NY
11520-1328
US

V. Phone/Fax

Practice location:
  • Phone: 516-379-6121
  • Fax: 516-379-6761
Mailing address:
  • Phone: 516-379-6121
  • Fax: 516-379-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number076328
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: