1407019813 NPI number — PETER JACOB PLOTNIK MD

Table of content: PETER JACOB PLOTNIK MD (NPI 1407019813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407019813 NPI number — PETER JACOB PLOTNIK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLOTNIK
Provider First Name:
PETER
Provider Middle Name:
JACOB
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PLOTNIK
Provider Other First Name:
PYOTR
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407019813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 UNION BLVD
Provider Second Line Business Mailing Address:
WALLINGTON CLINIC
Provider Business Mailing Address City Name:
WALLINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-471-1212
Provider Business Mailing Address Fax Number:
973-471-3311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 UNION BLVD
Provider Second Line Business Practice Location Address:
WALLINGTON CLINIC
Provider Business Practice Location Address City Name:
WALLINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-471-1212
Provider Business Practice Location Address Fax Number:
973-471-3311
Provider Enumeration Date:
07/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  MA047092 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)