Healthcare Provider Details

I. General information

NPI: 1306028725
Provider Name (Legal Business Name): MARINA PLOTKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 WYCKOFF AVE
RIDGEWOOD NY
11385-5360
US

IV. Provider business mailing address

951 WYCKOFF AVE
RIDGEWOOD NY
11385-5360
US

V. Phone/Fax

Practice location:
  • Phone: 718-326-2229
  • Fax: 718-326-2411
Mailing address:
  • Phone: 718-326-2229
  • Fax: 718-326-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: