Provider Demographics
NPI:1043846330
Name:PLUCHINO, MORA PLUCHINO
Entity type:Individual
Prefix:
First Name:MORA
Middle Name:PLUCHINO
Last Name:PLUCHINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S NEW YORK RD STE 23
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-6025
Mailing Address - Country:US
Mailing Address - Phone:093-300-9636
Mailing Address - Fax:
Practice Address - Street 1:107 BERESFORD DR
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-4881
Practice Address - Country:US
Practice Address - Phone:609-300-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA0133330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist