Provider Demographics
NPI:1740396126
Name:PLATNIK, BRUCE HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HOWARD
Last Name:PLATNIK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:652 SUFFOLK AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4391
Mailing Address - Country:US
Mailing Address - Phone:631-273-2403
Mailing Address - Fax:631-273-2324
Practice Address - Street 1:652 SUFFOLK AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4391
Practice Address - Country:US
Practice Address - Phone:631-273-2403
Practice Address - Fax:631-273-2324
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY094669208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00248357Medicaid