Provider Demographics
NPI:1689983488
Name:POLLEVICK, GUIDO DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:GUIDO
Middle Name:DANIEL
Last Name:POLLEVICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SCIENCE PARK
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1966
Mailing Address - Country:US
Mailing Address - Phone:203-786-3575
Mailing Address - Fax:413-235-6182
Practice Address - Street 1:5 SCIENCE PARK
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1966
Practice Address - Country:US
Practice Address - Phone:203-786-3575
Practice Address - Fax:413-235-6182
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPOLLG1OtherNEW YORK STATE DEPARTMENT OF HEALTH