Provider Demographics
NPI:1720342280
Name:PLETINSKAYA, VERONIKA (MS)
Entity type:Individual
Prefix:MRS
First Name:VERONIKA
Middle Name:
Last Name:PLETINSKAYA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 65TH PL
Mailing Address - Street 2:APT# 4G
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1349
Mailing Address - Country:US
Mailing Address - Phone:718-639-5333
Mailing Address - Fax:
Practice Address - Street 1:9825 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4627
Practice Address - Country:US
Practice Address - Phone:718-271-5637
Practice Address - Fax:718-271-0722
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY32639OtherLICENSE NUMBER