Provider Demographics
NPI:1518962380
Name:PLOTKIN, STUART (DPM)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:PLOTKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL DR
Mailing Address - Street 2:STE C
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1598
Mailing Address - Country:US
Mailing Address - Phone:631-928-8383
Mailing Address - Fax:631-928-8388
Practice Address - Street 1:2 MEDICAL DR
Practice Address - Street 2:STE C
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1598
Practice Address - Country:US
Practice Address - Phone:631-928-8383
Practice Address - Fax:631-928-8388
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002970213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50920Medicare UPIN