Provider Demographics
NPI:1689915357
Name:POLLAK, TAMARA BETH (WHNP (PREVIOUSLY RN))
Entity Type:Individual
Prefix:MISS
First Name:TAMARA
Middle Name:BETH
Last Name:POLLAK
Suffix:
Gender:F
Credentials:WHNP (PREVIOUSLY RN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83-21 57TH AVE,
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-898-1170
Mailing Address - Fax:718-898-3190
Practice Address - Street 1:83-21 57TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-898-1170
Practice Address - Fax:718-898-3190
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421135363LW0102X
NY485415163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency