Provider Demographics
NPI:1578149175
Name:POLYAK, IRYNA (MD)
Entity Type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:POLYAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 E 18TH ST APT B2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2923
Mailing Address - Country:US
Mailing Address - Phone:646-251-5785
Mailing Address - Fax:
Practice Address - Street 1:1812 E 18TH ST APT B2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2923
Practice Address - Country:US
Practice Address - Phone:646-251-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2832962174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist