Healthcare Provider Details

I. General information

NPI: 1588832422
Provider Name (Legal Business Name): STUART PLOTKIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL DR SUITE C
PRT JEFF STA NY
11776-1598
US

IV. Provider business mailing address

2 MEDICAL DR SUITE C
PRT JEFF STA NY
11776-1598
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-8383
  • Fax: 631-928-8388
Mailing address:
  • Phone: 631-928-8383
  • Fax: 631-928-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberN002970
License Number StateNY

VIII. Authorized Official

Name: DR. STUART PLOTKIN
Title or Position: OWNER
Credential: DPM
Phone: 631-928-8383