MEDICARE: DR. ROBERT PLUCHINO OD

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	152W00000X	Optometrist	005564	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679556823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT PLUCHINO OD

Provider Business Mailing Address
First Line	:	1 EDGEWATER ST
Second Line	:	6TH FL. PAYER RELATIONS
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4900
Country	:	US
Telephone Number	:	718-226-1008
Fax Number	:	718-226-1039

Provider Business Practice Location Address
First Line	:	242 MASON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3408
Country	:	US
Telephone Number	:	718-226-6284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	05/07/2008

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