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NPI Code Detail

MEDICARE: PLAZA MEDICAL & DIAGNOSTIC, P.C.

MEDICARE: PLAZA MEDICAL & DIAGNOSTIC, 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
1207Q00000XFamily Medicine Physician233446NY
2207Q00000XFamily Medicine Physician224877NY
3207QA0401XAddiction Medicine (Family Medicine) Physician108320NY
4207QG0300XGeriatric Medicine (Family Medicine) Physician108320NY
5208100000XPhysical Medicine & Rehabilitation Physician155061NY
6208100000XPhysical Medicine & Rehabilitation Physician097663NY
72081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician155061NY
8207Q00000XFamily Medicine Physician108320NY

General Provider Information

NPI Number : 1619091956
Entity Type Code : Organization
Provider Name (Legal Business Name) : PLAZA MEDICAL & DIAGNOSTIC, P.C.
Provider Business Mailing Address
First Line : 752 PARK AVE
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-3900
Country : US
Telephone Number : 631-385-0207
Fax Number : 631-385-1272
Provider Business Practice Location Address
First Line : 752 PARK AVE
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-3900
Country : US
Telephone Number : 631-385-0207
Fax Number : 631-385-1272
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. DEAN LOMBARDO
Credential :
Telephone Number : 631-385-0207
Provider Enumeration Date : 03/19/2007
Last Update Date : 03/04/2013

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Directions to “PLAZA MEDICAL & DIAGNOSTIC, P.C. ” Practice Location

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