Provider Demographics
NPI:1366864092
Name:PLAZA, JO-ANN (MSED)
Entity Type:Individual
Prefix:MS
First Name:JO-ANN
Middle Name:
Last Name:PLAZA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MISS
Other - First Name:JO-ANN
Other - Middle Name:
Other - Last Name:IMBRIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:123 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3101
Mailing Address - Country:US
Mailing Address - Phone:646-623-1181
Mailing Address - Fax:
Practice Address - Street 1:123 BRYANT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3101
Practice Address - Country:US
Practice Address - Phone:646-623-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist