Healthcare Provider Details

I. General information

NPI: 1790105807
Provider Name (Legal Business Name): LAURA PLITNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

IV. Provider business mailing address

875 KITCHAWAN RD
OSSINING NY
10562-1119
US

V. Phone/Fax

Practice location:
  • Phone: 914-592-7775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number838930
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: