Individual
DR. BERTRAM OLIVER PLOOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., BCBA-D
Contact information
Practice address
56 SAINT MARKS PL, STATEN ISLAND, NY 10301-1607
(718) 982-4083
Mailing address
56 SAINT MARKS PL, STATEN ISLAND, NY 10301-1607
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
000065-1
NY
103T00000X
Psychologist
Primary
021285
NY
Other
Enumeration date
06/08/2009
Last updated
11/30/2015
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