MEDICARE: DR. LARRY JEFFREY PLEENER M.D.

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	207Q00000X	Family Medicine Physician	156232	NY

General Provider Information

NPI Number	:	1962498477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY JEFFREY PLEENER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 802
Second Line	:
City	:	BELLMORE
State	:	NY
Zip	:	11710-0802
Country	:	US
Telephone Number	:	516-783-0256
Fax Number	:

Provider Business Practice Location Address
First Line	:	1836 BELLMORE AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-5554
Country	:	US
Telephone Number	:	516-783-0256
Fax Number	:

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	07/09/2007

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