Provider Demographics
NPI:1790050425
Name:PLUCKNETTE, BENJAMIN FOREST (DO)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:FOREST
Last Name:PLUCKNETTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAGEN DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2696
Mailing Address - Country:US
Mailing Address - Phone:585-295-5390
Mailing Address - Fax:
Practice Address - Street 1:30 HAGEN DR STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2696
Practice Address - Country:US
Practice Address - Phone:585-295-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326790-012086S0105X
IL036.147240207XS0106X
390200000X
TXS4546207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program