Provider Demographics
NPI:1760468409
Name:POLLACK, STEPHEN B (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:POLLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3706
Mailing Address - Country:US
Mailing Address - Phone:716-689-7330
Mailing Address - Fax:716-689-6881
Practice Address - Street 1:1630 MAPLE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3706
Practice Address - Country:US
Practice Address - Phone:716-689-7330
Practice Address - Fax:716-689-6881
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1542811207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00949459Medicaid
NY4378860001Medicare PIN
NY009341Medicare PIN
D01448Medicare UPIN