MEDICARE: MIKHAIL PLOTNITSKIY, D.O., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	245179	NY

General Provider Information

NPI Number	:	1457582124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKHAIL PLOTNITSKIY, D.O., P.C.

Provider Business Mailing Address
First Line	:	265 W PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3222
Country	:	US
Telephone Number	:	516-897-0708
Fax Number	:	516-431-4107

Provider Business Practice Location Address
First Line	:	265 W PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3222
Country	:	US
Telephone Number	:	516-897-0708
Fax Number	:	516-431-4107

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS ERIN M HACK
Credential	:
Telephone Number	:	516-897-0708

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	08/05/2009

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