Healthcare Provider Details

I. General information

NPI: 1154548477
Provider Name (Legal Business Name): PLAINVIEW OBS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 S OYSTER BAY RD
PLAINVIEW NY
11803-3312
US

IV. Provider business mailing address

459 S OYSTER BAY RD
PLAINVIEW NY
11803-3312
US

V. Phone/Fax

Practice location:
  • Phone: 516-433-4447
  • Fax: 516-932-5268
Mailing address:
  • Phone: 516-433-4447
  • Fax: 516-932-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number445580
License Number StateNY

VIII. Authorized Official

Name: PAUL DRUCKER
Title or Position: OWNER
Credential: DPM
Phone: 516-433-4447