Provider Demographics
NPI:1700833530
Name:PLUTA, CHRISTINE (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:PLUTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WHITE HORSE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-1412
Mailing Address - Country:US
Mailing Address - Phone:866-206-2866
Mailing Address - Fax:609-208-3233
Practice Address - Street 1:310 WHITE HORSE AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-1412
Practice Address - Country:US
Practice Address - Phone:866-206-2866
Practice Address - Fax:609-208-3233
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011060207Q00000X
NJ25MB06985400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01952172Medicaid
PA01952172Medicaid
PA071786Medicare ID - Type Unspecified