Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 25MA09288300 | NJ |
NPI | 1457593261 |
---|---|
Provider Name | Christos Plakas |
First Address | Long Branch, NJ 07740-0359 |
Second Address | Little Silver, NJ 07739-1160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2009 |
Last Update Date | 24/11/2019 |