Provider Demographics
NPI:1639432370
Name:POLANCO, DINORAH (MSED)
Entity Type:Individual
Prefix:MS
First Name:DINORAH
Middle Name:
Last Name:POLANCO
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 1:34 N 6TH ST APT 8A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3073
Mailing Address - Country:US
Mailing Address - Phone:347-599-0455
Mailing Address - Fax:347-599-0455
Practice Address - Street 1:34 N 6TH ST APT 8A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-3073
Practice Address - Country:US
Practice Address - Phone:347-599-0455
Practice Address - Fax:347-599-0455
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency