Provider Demographics
NPI:1811926983
Name:PLANCHER ORTHOPAEDICS & SPORTS MEDICINE,PLLC
Entity type:Organization
Organization Name:PLANCHER ORTHOPAEDICS & SPORTS MEDICINE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PLANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-863-2003
Mailing Address - Street 1:1160 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1212
Mailing Address - Country:US
Mailing Address - Phone:212-876-5200
Mailing Address - Fax:212-876-4440
Practice Address - Street 1:31 RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2152
Practice Address - Country:US
Practice Address - Phone:203-863-2003
Practice Address - Fax:203-863-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030654207X00000X
NY181664207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5114460001Medicare NSC
CT5091060001Medicare NSC
NYWCK332Medicare PIN
CT200000864Medicare PIN
CTC02922Medicare PIN