Provider Demographics
NPI:1578530010
Name:POLACK, NOHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NOHA
Middle Name:
Last Name:POLACK
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 1:3196 KENNEDY BLVD
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2436
Mailing Address - Country:US
Mailing Address - Phone:201-319-9800
Mailing Address - Fax:201-319-9849
Practice Address - Street 1:3196 KENNEDY BLVD
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2436
Practice Address - Country:US
Practice Address - Phone:201-319-9800
Practice Address - Fax:201-319-9849
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63880208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K0951NOtherHEALTHNET OF NORTHEAST
NY559531Other559531
NJP1237291OtherOXFORD HEALTHCARE
NJJ6791OtherHORIZON BCBSNJ
NJ1086830OtherHORIZON NJ HEATHCARE
NY2602850OtherGHI
NJ1771005OtherCIGNA HEALTHCARE
NJ1771005OtherCIGNA HEALTHCARE
NJJ6791OtherHORIZON BCBSNJ