Provider Demographics
NPI:1174272926
Name:PLOTKIN, JORDAN IAN
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:IAN
Last Name:PLOTKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 ROLLING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6928
Mailing Address - Country:US
Mailing Address - Phone:845-825-7189
Mailing Address - Fax:
Practice Address - Street 1:977 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1843
Practice Address - Country:US
Practice Address - Phone:732-418-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI029745001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program