Healthcare Provider Details

I. General information

NPI: 1225761653
Provider Name (Legal Business Name): INDIRA PLAISIMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2022
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THEALL RD
RYE NY
10580-1404
US

IV. Provider business mailing address

1 THEALL RD
RYE NY
10580-1404
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6737
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number032558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: