Provider Demographics
NPI:1558899971
Name:ILANA GELFOND POLNARIEV OD PC
Entity Type:Organization
Organization Name:ILANA GELFOND POLNARIEV OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELFOND-POLNARIEV
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-481-2020
Mailing Address - Street 1:4300 HYLAN BLVD STE 1BC
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6507
Mailing Address - Country:US
Mailing Address - Phone:718-481-2020
Mailing Address - Fax:844-464-7404
Practice Address - Street 1:4300 HYLAN BLVD STE 1BC
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6507
Practice Address - Country:US
Practice Address - Phone:718-481-2020
Practice Address - Fax:844-464-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0065888152W00000X
NY006588152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty