Provider Demographics
NPI:1568868826
Name:POLLACK, GILA
Entity Type:Individual
Prefix:
First Name:GILA
Middle Name:
Last Name:POLLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 150TH ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2988
Mailing Address - Country:US
Mailing Address - Phone:718-989-9657
Mailing Address - Fax:347-505-7060
Practice Address - Street 1:7505 150TH ST APT 2D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2988
Practice Address - Country:US
Practice Address - Phone:718-989-9657
Practice Address - Fax:347-505-7060
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY896929141174400000X
NY501162111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2299411OtherTEACHER ID#