Provider Demographics
NPI:1285817692
Name:PLAISIMOND, JUDE
Entity Type:Individual
Prefix:MR
First Name:JUDE
Middle Name:
Last Name:PLAISIMOND
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 1:169 N 28TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2008
Mailing Address - Country:US
Mailing Address - Phone:631-643-1117
Mailing Address - Fax:631-643-1117
Practice Address - Street 1:169 N 28TH ST
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-2008
Practice Address - Country:US
Practice Address - Phone:631-643-1117
Practice Address - Fax:631-643-1117
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287252164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse