Provider Demographics
NPI:1073629994
Name:POLLACK, ARYEH L (MD)
Entity Type:Individual
Prefix:
First Name:ARYEH
Middle Name:L
Last Name:POLLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2740
Mailing Address - Country:US
Mailing Address - Phone:718-436-9554
Mailing Address - Fax:718-436-3912
Practice Address - Street 1:4701 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-436-9554
Practice Address - Fax:718-436-3912
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204011207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY403B71Medicare ID - Type Unspecified
NYH34030Medicare UPIN