Active NPI
Bruce Howard Platnik, MD
- Pediatrics Physician
- Brentwood, NY
National Provider Identifier
1740396126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 094669
- Practice address
- 652 Suffolk Ave
Suite 104
Brentwood, NY 11717-4391 - Phone
- (631) 273-2403
- Fax
- (631) 273-2324
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 094669 | NY | Primary |
Addresses
Primary practice location
652 Suffolk Ave
Suite 104
Brentwood, NY 11717-4391
Mailing address
652 Suffolk Ave
Suite 104
Brentwood, NY 11717-4391
Phone (631) 273-2403
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00248357 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160917000023 | NY | Order and Referring Only - Pediatric Medicine | 1759678899 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 094669 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740396126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "652 SUFFOLK AVE",
"address_2": "SUITE 104",
"city": "BRENTWOOD",
"state": "NY",
"postal_code": "117174391",
"telephone_number": "631-273-2403",
"fax_number": "631-273-2324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "652 SUFFOLK AVE",
"address_2": "SUITE 104",
"city": "BRENTWOOD",
"state": "NY",
"postal_code": "117174391",
"telephone_number": "631-273-2403",
"fax_number": "631-273-2324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLATNIK",
"first_name": "BRUCE",
"middle_name": "HOWARD",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "094669",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00248357",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brentwood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.