Provider Demographics
NPI:1710382999
Name:POLYAK, MARGARITA
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:POLYAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 508
Mailing Address - Street 2:
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328-9744
Mailing Address - Country:US
Mailing Address - Phone:646-648-0312
Mailing Address - Fax:
Practice Address - Street 1:26 CASS PL
Practice Address - Street 2:APT 6B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4757
Practice Address - Country:US
Practice Address - Phone:646-648-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059536183500000X
NY28059536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist