Provider Demographics
NPI:1629531462
Name:MENDELEVICH, POLINA (MSED)
Entity Type:Individual
Prefix:
First Name:POLINA
Middle Name:
Last Name:MENDELEVICH
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 VALLEY GREENS DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3634
Mailing Address - Country:US
Mailing Address - Phone:718-614-1224
Mailing Address - Fax:
Practice Address - Street 1:10023 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5501
Practice Address - Country:US
Practice Address - Phone:718-614-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist