Provider Demographics
NPI:1275813321
Name:YUSIM, POLINA
Entity Type:Individual
Prefix:
First Name:POLINA
Middle Name:
Last Name:YUSIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1907
Mailing Address - Country:US
Mailing Address - Phone:718-646-6200
Mailing Address - Fax:718-648-0836
Practice Address - Street 1:3723 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1907
Practice Address - Country:US
Practice Address - Phone:718-646-6200
Practice Address - Fax:718-648-0836
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008999156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician