Provider Demographics
NPI:1063698496
Name:ELLIOT L PLOTKIN DPM
Entity type:Organization
Organization Name:ELLIOT L PLOTKIN DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PLOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-363-9844
Mailing Address - Street 1:185 BRIDGE PLZ N
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5907
Mailing Address - Country:US
Mailing Address - Phone:201-363-9844
Mailing Address - Fax:
Practice Address - Street 1:185 BRIDGE PLZ N
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5907
Practice Address - Country:US
Practice Address - Phone:201-363-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001660213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45603Medicare UPIN