Healthcare Provider Details

I. General information

NPI: 1700467677
Provider Name (Legal Business Name): LUKE PLIZGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK UNIVERSITY HOSPITAL DEPARTMENT OF SURGERY 101 NICOLLS RD
STONY BROOK NY
10704-8434
US

IV. Provider business mailing address

101 NICOLLS RD # HSC19030
STONY BROOK NY
11794-0001
US

V. Phone/Fax

Practice location:
  • Phone: 631-638-2698
  • Fax: 631-638-0069
Mailing address:
  • Phone: 631-638-2698
  • Fax: 631-638-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: