Provider Demographics
NPI:1710389135
Name:POLIANDRO, EDWARD J (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:POLIANDRO
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 1:211 WEST 56 ST.
Mailing Address - Street 2:APT 16H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4320
Mailing Address - Country:US
Mailing Address - Phone:212-333-5821
Mailing Address - Fax:
Practice Address - Street 1:211 WEST 56 ST.
Practice Address - Street 2:APT 16H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4320
Practice Address - Country:US
Practice Address - Phone:212-333-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21504R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical