Provider Demographics
NPI:1407918188
Name:PLAN, MICHAEL B (PT, MS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:PLAN
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Gender:M
Credentials:PT, MS
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Mailing Address - Street 1:4175 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7639
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:450 AMWELL RD
Practice Address - Street 2:AMWELL MALL
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1218
Practice Address - Country:US
Practice Address - Phone:908-359-3744
Practice Address - Fax:908-359-6761
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2009-11-11
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA00209200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ139044SRMOtherMEDICARE