Provider Demographics
NPI:1356402473
Name:PLOETZKE, LAURA (ANP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:PLOETZKE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 GARDINERS AVE STE 344
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3705
Mailing Address - Country:US
Mailing Address - Phone:516-847-1277
Mailing Address - Fax:516-586-4307
Practice Address - Street 1:1 MERRITTS RD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-1817
Practice Address - Country:US
Practice Address - Phone:516-459-2939
Practice Address - Fax:516-586-4307
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300672363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P2749398OtherOXFORD
36440POtherHIP
P00221176OtherRR MCR
2036567OtherUHC
AA70381AOtherMDNY
DN0351OtherPHS
2C7632OtherHEALTHNET
7599365OtherGHI
201285536OtherGALAXY
201285536OtherPHCS
0853G1OtherBLUE CROSS BLUE SHIELD
P00221176OtherRR MCR
201285536OtherPHCS