Provider Demographics
NPI:1225008089
Name:POLLAK, SAMUEL P (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:P
Last Name:POLLAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LYNCREST DR
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1630
Mailing Address - Country:US
Mailing Address - Phone:845-425-0043
Mailing Address - Fax:845-354-6335
Practice Address - Street 1:22 LYNCREST DR
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1630
Practice Address - Country:US
Practice Address - Phone:845-425-0043
Practice Address - Fax:845-354-6335
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT003781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00403030Medicaid
NYU29474Medicare UPIN
NY00403030Medicaid