Healthcare Provider Details

I. General information

NPI: 1609515394
Provider Name (Legal Business Name): PLESSEN ENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 ESTATE LA GRANDE PRINCESSE STE 1
CHRISTIANSTED VI
00820-5166
US

IV. Provider business mailing address

3004 ORANGE GROVE SUITE 2
CHRISTIANSTED VI
00820
US

V. Phone/Fax

Practice location:
  • Phone: 340-715-7720
  • Fax: 340-713-9002
Mailing address:
  • Phone: 340-715-7720
  • Fax: 340-713-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAN BIJAN TAWAKOL
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 602-885-3917