Provider Demographics
NPI:1306028725
Name:PLOTKIN, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:PLOTKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5360
Mailing Address - Country:US
Mailing Address - Phone:718-326-2229
Mailing Address - Fax:718-326-2411
Practice Address - Street 1:951 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5360
Practice Address - Country:US
Practice Address - Phone:718-326-2229
Practice Address - Fax:718-326-2411
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02617669Medicaid