Provider Demographics
NPI:1104017110
Name:REESE E POLESKY MD INC.
Entity Type:Organization
Organization Name:REESE E POLESKY MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REESE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:POLESKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-281-2111
Mailing Address - Street 1:50 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2227
Mailing Address - Country:US
Mailing Address - Phone:310-281-2111
Mailing Address - Fax:310-281-2118
Practice Address - Street 1:703 N CAMDEN DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-3204
Practice Address - Country:US
Practice Address - Phone:310-281-2111
Practice Address - Fax:310-281-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG6438207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW162Medicare PIN
CA0946420001Medicare NSC