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General NPI Number Information
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NPI Number | 1235540352
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Entity Type | Organization
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Legal Business Name | ANTOINETTE PLOCEK NOTARO MD PC
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 13405 MAIN ROAD
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City | MATTITUCK
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State | NY
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Zip | 11952
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Country | US
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Telephone | 631-298-1122
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Fax | 631-298-1128
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Provider Business Mailing Address
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Address Line | PO BOX 93
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City | MATTITUCK
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State | NY
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Zip | 11952-0093
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Country | US
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Telephone | 631-298-1122
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Fax | 631-298-1128
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTOINETTE NOTARO
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Credential | M.D.
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Telephone | 631-298-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 139181
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License Number State | NY
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