Provider Demographics
NPI:1588832422
Name:STUART PLOTKIN
Entity Type:Organization
Organization Name:STUART PLOTKIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-928-8383
Mailing Address - Street 1:2 MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PRT JEFF STA
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:SUITE C
Practice Address - City:PRT JEFF STA
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002970335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP32291Medicare PIN
NY0829810001Medicare NSC
T50920Medicare UPIN