Provider Demographics
NPI:1023208550
Name:PLOTNITSKIY, MIKHAIL (DO)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:PLOTNITSKIY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 E MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5984
Mailing Address - Country:US
Mailing Address - Phone:516-431-1919
Mailing Address - Fax:516-431-8642
Practice Address - Street 1:85 E MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5984
Practice Address - Country:US
Practice Address - Phone:516-431-1919
Practice Address - Fax:516-431-8642
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245179-1207V00000X
CA20A 10142207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02900241Medicaid
NY02900241Medicaid