Provider Demographics
NPI:1922128628
Name:PLANTZ, ELMER F JR (NNP)
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:F
Last Name:PLANTZ
Suffix:JR
Gender:M
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 COUNTY ROUTE 22
Mailing Address - Street 2:PO BOX 435
Mailing Address - City:ALTMAR
Mailing Address - State:NY
Mailing Address - Zip Code:13302-3303
Mailing Address - Country:US
Mailing Address - Phone:315-298-7728
Mailing Address - Fax:
Practice Address - Street 1:110 W 6TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2507
Practice Address - Country:US
Practice Address - Phone:315-349-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350092-1363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal