Provider Demographics
NPI:1174620256
Name:POLITSKY, JEFFREY MARK (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:POLITSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 WESTCHESTER AVE
Mailing Address - Street 2:SUITE E104
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2910
Mailing Address - Country:US
Mailing Address - Phone:914-428-9213
Mailing Address - Fax:914-428-9282
Practice Address - Street 1:333 WESTCHESTER AVE
Practice Address - Street 2:SUITE E104
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2910
Practice Address - Country:US
Practice Address - Phone:914-428-9213
Practice Address - Fax:914-428-9282
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ106441M602084N0400X
NY2413192080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G97155Medicare UPIN