Provider Demographics
NPI:1407851355
Name:POLAKOFF, DONALD R (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:POLAKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 UNION VALLEY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-6000
Mailing Address - Country:US
Mailing Address - Phone:609-655-1818
Mailing Address - Fax:609-655-1814
Practice Address - Street 1:111 UNION VALLEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-6000
Practice Address - Country:US
Practice Address - Phone:609-655-1818
Practice Address - Fax:609-655-1814
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA45959207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD19781Medicare UPIN