Provider Demographics
NPI:1467478172
Name:POLLACK, LOREY HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREY
Middle Name:HARRIS
Last Name:POLLACK
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 1:2000 N VILLAGE AVE
Mailing Address - Street 2:SUITE104
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1078
Mailing Address - Country:US
Mailing Address - Phone:516-678-4222
Mailing Address - Fax:516-678-0919
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE104
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-678-4222
Practice Address - Fax:516-678-0919
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118985207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY118985OtherSTATE LICENSE NUMBER
C08300Medicare UPIN
351851Medicare ID - Type Unspecified