Provider Demographics
NPI:1962498477
Name:PLEENER, LARRY JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JEFFREY
Last Name:PLEENER
Suffix:
Gender:M
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:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-0802
Mailing Address - Country:US
Mailing Address - Phone:516-783-0256
Mailing Address - Fax:
Practice Address - Street 1:1836 BELLMORE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5554
Practice Address - Country:US
Practice Address - Phone:516-783-0256
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY37D461Medicare PIN
NYA62554Medicare UPIN