Provider Demographics
NPI:1467538298
Name:POLISNER, STUART BARRY (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:BARRY
Last Name:POLISNER
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 1:160 COMMACK RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3412
Mailing Address - Country:US
Mailing Address - Phone:631-499-6699
Mailing Address - Fax:631-499-6617
Practice Address - Street 1:160 COMMACK RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3412
Practice Address - Country:US
Practice Address - Phone:631-499-6699
Practice Address - Fax:631-499-6617
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS092664207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery