Healthcare Provider Details

I. General information

NPI: 1750840435
Provider Name (Legal Business Name): JESSICA G PLOOF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 BALDWIN RD
RUSHVILLE NY
14544-9738
US

IV. Provider business mailing address

131 DRUMLIN CT
NEWARK NY
14513-1863
US

V. Phone/Fax

Practice location:
  • Phone: 585-755-2639
  • Fax:
Mailing address:
  • Phone: 585-755-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number547342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: