Provider Demographics
NPI:1235540352
Name:ANTOINETTE PLOCEK NOTARO MD PC
Entity Type:Organization
Organization Name:ANTOINETTE PLOCEK NOTARO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-298-1122
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-0093
Mailing Address - Country:US
Mailing Address - Phone:631-298-1122
Mailing Address - Fax:631-298-1128
Practice Address - Street 1:13405 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952
Practice Address - Country:US
Practice Address - Phone:631-298-1122
Practice Address - Fax:631-298-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139181261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB14278Medicare UPIN