Healthcare Provider Details

I. General information

NPI: 1790050425
Provider Name (Legal Business Name): BENJAMIN FOREST PLUCKNETTE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HAGEN DR STE 220
ROCHESTER NY
14625-2696
US

IV. Provider business mailing address

30 HAGEN DR STE 220
ROCHESTER NY
14625-2696
US

V. Phone/Fax

Practice location:
  • Phone: 585-295-5390
  • Fax:
Mailing address:
  • Phone: 585-295-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number326790-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: