Healthcare Provider Details

I. General information

NPI: 1689725293
Provider Name (Legal Business Name): JESSICA PLOTNICK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 EAST 17TH ST.
NEW YORK NY
10003
US

IV. Provider business mailing address

407 AIRPORT EXE PARK
NANUET NY
10954
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006369
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: