Provider Demographics
NPI:1376140897
Name:BARRY S POLINER MD
Entity Type:Organization
Organization Name:BARRY S POLINER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:POLINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-445-1304
Mailing Address - Street 1:24 CURRY CT
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9003
Mailing Address - Country:US
Mailing Address - Phone:386-445-1304
Mailing Address - Fax:
Practice Address - Street 1:33 OLD KINGS RD N STE 3
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8238
Practice Address - Country:US
Practice Address - Phone:386-445-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty