Provider Demographics
NPI:1619972361
Name:GELFOND-POLNARIEV, ILANA (OD)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:
Last Name:GELFOND-POLNARIEV
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ILANA
Other - Middle Name:
Other - Last Name:GELFOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
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:
Practice Address - Street 1:4300 HYLAN BLVD STE 1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6505
Practice Address - Country:US
Practice Address - Phone:718-481-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006588152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02499796Medicaid
NY02499796Medicaid
NYU92326Medicare UPIN