Provider Demographics
NPI:1518042902
Name:POLLAK, IRA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:M
Last Name:POLLAK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CANTIAGUE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1402
Mailing Address - Country:US
Mailing Address - Phone:516-937-1440
Mailing Address - Fax:516-937-1440
Practice Address - Street 1:700 CANTIAGUE ROCK RD
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1402
Practice Address - Country:US
Practice Address - Phone:516-937-1440
Practice Address - Fax:516-937-1440
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009231103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01055334Medicaid
NY01055334Medicaid