Provider Demographics
NPI:1508232976
Name:PLISIC, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PLISIC
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 1:16311 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1013
Mailing Address - Country:US
Mailing Address - Phone:917-273-8652
Mailing Address - Fax:
Practice Address - Street 1:436 WILLIS AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WILLISTON PK
Practice Address - State:NY
Practice Address - Zip Code:11596-2298
Practice Address - Country:US
Practice Address - Phone:516-741-0729
Practice Address - Fax:516-209-4556
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health