Provider Demographics
NPI:1407019813
Name:PLOTNIK, PETER JACOB (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JACOB
Last Name:PLOTNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PYOTR
Other - Middle Name:
Other - Last Name:PLOTNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:46 UNION BLVD
Mailing Address - Street 2:WALLINGTON CLINIC
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057
Mailing Address - Country:US
Mailing Address - Phone:973-471-1212
Mailing Address - Fax:973-471-3311
Practice Address - Street 1:46 UNION BLVD
Practice Address - Street 2:WALLINGTON CLINIC
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057
Practice Address - Country:US
Practice Address - Phone:973-471-1212
Practice Address - Fax:973-471-3311
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA047092208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice