Provider Demographics
NPI:1922003920
Name:NOTARO, ANTOINETTE PLOCEK (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:PLOCEK
Last Name:NOTARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13405 MAIN RD., PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-0093
Mailing Address - Country:US
Mailing Address - Phone:631-298-1122
Mailing Address - Fax:631-298-1128
Practice Address - Street 1:13405 MAIN RD.
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-0093
Practice Address - Country:US
Practice Address - Phone:631-298-1122
Practice Address - Fax:631-298-1128
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139181207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B14278Medicare UPIN
75A011Medicare ID - Type Unspecified