Provider Demographics
NPI:1306837323
Name:POLSKY, JO-ANN BERGERON (BS, MPH, RD)
Entity Type:Individual
Prefix:MS
First Name:JO-ANN
Middle Name:BERGERON
Last Name:POLSKY
Suffix:
Gender:F
Credentials:BS, MPH, RD
Other - Prefix:MS
Other - First Name:JO-ANN
Other - Middle Name:
Other - Last Name:BERGERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:RHODE ISLAND HOSPITAL POB 334
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-4422
Mailing Address - Fax:401-444-4416
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:RHODE ISLAND HOSPITAL POB 334
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4422
Practice Address - Fax:401-444-4416
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00151133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN