Provider Demographics
NPI:1225330541
Name:OSMANOFF, POLINA (PA)
Entity Type:Individual
Prefix:MRS
First Name:POLINA
Middle Name:
Last Name:OSMANOFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:POLINA
Other - Middle Name:
Other - Last Name:AVETISYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:505 RARITAN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2901
Mailing Address - Country:US
Mailing Address - Phone:732-393-1331
Mailing Address - Fax:
Practice Address - Street 1:505 RARITAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2901
Practice Address - Country:US
Practice Address - Phone:732-393-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00248700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant