Provider Demographics
NPI:1073542312
Name:POLLACK, ELLIOT S (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:S
Last Name:POLLACK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9519
Mailing Address - Country:US
Mailing Address - Phone:860-653-4708
Mailing Address - Fax:860-653-6249
Practice Address - Street 1:133 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9519
Practice Address - Country:US
Practice Address - Phone:860-653-4708
Practice Address - Fax:860-653-6249
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000144213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0869800001OtherMEDICARE DME
CT0869800002OtherMEDICARE DME
CT0610129323OtherTAX ID
CT0610129323OtherTAX ID