Organization Name: | PLAZA PODIATRY PLLC |
NPI Number: | 1114350212 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WENDY A BARABAN (OWNER) |
Mailing Address: | 325 Middle Country Rd Suite 4 Selden |
State: | NY US |
Postal Code: | 117842545 |
Phone Number: | 6313201990 |
Fax Number: | 6313201988 |
NPI Enumeration Date: | 08/13/2013 |
NPI Last Update Date: | 09/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | N005620 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |