Provider Demographics
NPI:1487810289
Name:ROBERT L PLUMMER MD FACS PC
Entity type:Organization
Organization Name:ROBERT L PLUMMER MD FACS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PLUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS PC
Authorized Official - Phone:718-367-6100
Mailing Address - Street 1:176 E MOSHOLU PK WY S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1174
Mailing Address - Country:US
Mailing Address - Phone:718-367-6100
Mailing Address - Fax:718-733-4020
Practice Address - Street 1:176 E MOSHOLU PK WY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1174
Practice Address - Country:US
Practice Address - Phone:718-367-6100
Practice Address - Fax:718-733-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01165902Medicaid