Provider Demographics
NPI:1326202706
Name:POLLACK, ANDREA LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LEE
Last Name:POLLACK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:LAURIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:363 ROUTE 111
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4756
Mailing Address - Country:US
Mailing Address - Phone:631-724-9394
Mailing Address - Fax:
Practice Address - Street 1:363 ROUTE 111
Practice Address - Street 2:SUITE 101
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4756
Practice Address - Country:US
Practice Address - Phone:631-724-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine