Organization Active NPI

Laura Ploetzke Adult Health Nurse Practitioner, PC

  • Adult Health Nurse Practitioner
  • Farmingdale, NY
National Provider Identifier
1629410865
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F300672 Issued in NY
Legal business name
LAURA PLOETZKE ADULT HEALTH NURSE PRACTITIONER, PC
Practice address
1 Merritt Rd
Farmingdale, NY 11735-1817
Phone
(516) 459-2939
NPI assigned
Jul 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Ploetzke, NPNPI 1356402473
Title
Owner
Phone
(516) 864-0040

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X F300672 NY Primary

Addresses

Primary practice location

1 Merritt Rd
Farmingdale, NY 11735-1817

Mailing address

1 Merritt Rd
Farmingdale, NY 11735-1817
Phone (516) 864-0040

Other identifiers 1

IdentifierTypeStateIssuer
F300672-01OtherNYLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131212001153 NY Part B Supplier - Clinic/Group Practice 5890922124 Receives reassigned benefits from 3 practitioners
Practice locations: Farmingdale, NY

National Provider Directory

National Provider Directory

Locations

200 Boundary Ave
Ste 200
Massapequa, NY 11758
Phone (516) 755-2404

60 Queens St
Ste 100
Syosset, NY 11791
Phone (347) 267-0904

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1629410865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MERRITT RD",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117351817",
            "telephone_number": "516-864-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MERRITT RD",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117351817",
            "telephone_number": "516-459-2939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURA PLOETZKE ADULT HEALTH NURSE PRACTITIONER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-29",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A",
        "authorized_official_last_name": "PLOETZKE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-864-0040",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F300672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "F300672-01",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmingdale, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.