Healthcare Provider Details

I. General information

NPI: 1982405411
Provider Name (Legal Business Name): PLANKEN INTEGRATIVE WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 MERRICK RD
WANTAGH NY
11793-4343
US

IV. Provider business mailing address

3401 MERRICK RD
WANTAGH NY
11793-4343
US

V. Phone/Fax

Practice location:
  • Phone: 516-783-4421
  • Fax:
Mailing address:
  • Phone: 516-783-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MACARENA PLANKEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 516-783-4421