Healthcare Provider Details

I. General information

NPI: 1104780204
Provider Name (Legal Business Name): DANIELLA ISABELLE PLOTKIN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 VEDDER AVE
STATEN ISLAND NY
10314-1509
US

IV. Provider business mailing address

11 HARTFORD ST
STATEN ISLAND NY
10308-3423
US

V. Phone/Fax

Practice location:
  • Phone: 917-728-7219
  • Fax:
Mailing address:
  • Phone: 917-728-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: