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General NPI Number Information
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NPI Number | 1114350212
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Entity Type | Organization
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Legal Business Name | PLAZA PODIATRY PLLC
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 325 MIDDLE COUNTRY RD SUITE 4
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City | SELDEN
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State | NY
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Zip | 11784-2545
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Country | US
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Telephone | 631-320-1990
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Fax | 631-320-1988
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Provider Business Mailing Address
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Address Line | 325 MIDDLE COUNTRY RD SUITE 4
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City | SELDEN
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State | NY
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Zip | 11784-2545
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Country | US
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Telephone | 631-320-1990
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Fax | 631-320-1988
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Authorized Official
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Title or Position | OWNER
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Name | WENDY A BARABAN
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Credential | DPM
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Telephone | 631-320-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | N005620
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License Number State | NY
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