Healthcare Provider Details

I. General information

NPI: 1497132302
Provider Name (Legal Business Name): MICHELLE PLOEGMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 LONGWOOD RD
MIDDLE ISLAND NY
11953-2045
US

IV. Provider business mailing address

PO BOX 12 LONGWOOD ROAD
MIDDLE ISLAND NY
11953-0012
US

V. Phone/Fax

Practice location:
  • Phone: 631-924-0008
  • Fax: 631-924-1243
Mailing address:
  • Phone: 631-924-0008
  • Fax: 631-924-1243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number090650-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: