Provider Demographics
NPI:1467479410
Name:MILA POLONSKY, M.D.
Entity Type:Organization
Organization Name:MILA POLONSKY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-644-9000
Mailing Address - Street 1:101 MADISON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7357
Mailing Address - Country:US
Mailing Address - Phone:973-644-9000
Mailing Address - Fax:973-644-9282
Practice Address - Street 1:101 MADISON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7357
Practice Address - Country:US
Practice Address - Phone:973-644-9000
Practice Address - Fax:973-644-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59802174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG05752Medicare UPIN