Healthcare Provider Details

I. General information

NPI: 1144364530
Provider Name (Legal Business Name): ANDREA B. KAPLAN, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL PLAZA SUITE 306
GLEN COVE NY
11542
US

IV. Provider business mailing address

10 MEDICAL PLAZA SUITE 306
GLEN COVE NY
11542
US

V. Phone/Fax

Practice location:
  • Phone: 516-609-0346
  • Fax: 516-609-0353
Mailing address:
  • Phone: 516-609-0346
  • Fax: 516-609-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200525
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number200525
License Number StateNY

VIII. Authorized Official

Name: DR. ANDREA B KAPLAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-609-0346