Provider Demographics
NPI:1346432077
Name:POLAK, ILONA KATARZYNA (MD)
Entity Type:Individual
Prefix:MISS
First Name:ILONA
Middle Name:KATARZYNA
Last Name:POLAK
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2986
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-0402
Mailing Address - Country:US
Mailing Address - Phone:631-808-3337
Mailing Address - Fax:631-808-3339
Practice Address - Street 1:34 BAY ST # 103
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-3104
Practice Address - Country:US
Practice Address - Phone:631-808-3337
Practice Address - Fax:631-808-3339
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY245282-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300046311Medicare PIN