Provider Demographics
NPI:1114350212
Name:PLAZA PODIATRY PLLC
Entity Type:Organization
Organization Name:PLAZA PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARABAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-320-1990
Mailing Address - Street 1:325 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2545
Mailing Address - Country:US
Mailing Address - Phone:631-320-1990
Mailing Address - Fax:631-320-1988
Practice Address - Street 1:325 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2545
Practice Address - Country:US
Practice Address - Phone:631-320-1990
Practice Address - Fax:631-320-1988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WENDY BARABAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-13
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005620213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty