Provider Demographics
NPI:1689822256
Name:POLANCO, GESENIA B (TSHH)
Entity Type:Individual
Prefix:
First Name:GESENIA
Middle Name:B
Last Name:POLANCO
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1742
Mailing Address - Country:US
Mailing Address - Phone:201-488-2009
Mailing Address - Fax:
Practice Address - Street 1:225 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1742
Practice Address - Country:US
Practice Address - Phone:201-488-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant