Basic Information
| Provider Information | |||||||||
| NPI: | 1467617233 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PLAZA OBS MEDICAL, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 234856 | ||||||||
| Address2: | |||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110234856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312771803 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 GARDEN CITY PLZ | ||||||||
| Address2: | SUITE 100A | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115303301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312771803 | ||||||||
| FaxNumber: | 6315810015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2008 | ||||||||
| LastUpdateDate: | 07/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | TERRANI | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 6312771803 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.