Healthcare Provider Details

I. General information

NPI: 1801891577
Provider Name (Legal Business Name): MICHAEL ALAN PLISKIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S MIDDLE NECK RD STE LB
GREAT NECK NY
11021-3486
US

IV. Provider business mailing address

75 S MIDDLE NECK RD STE LB
GREAT NECK NY
11021-3486
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-8107
  • Fax: 516-487-3016
Mailing address:
  • Phone: 516-487-8107
  • Fax: 516-487-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: