Provider Demographics
NPI:1174639322
Name:POLONSKY, TATIANNA (MD)
Entity Type:Individual
Prefix:
First Name:TATIANNA
Middle Name:
Last Name:POLONSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:760 BROADWAY
Mailing Address - Street 2:5A-123
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5317
Mailing Address - Country:US
Mailing Address - Phone:718-963-8419
Mailing Address - Fax:718-630-3138
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:5A-123
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-8419
Practice Address - Fax:718-630-3138
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2114212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry