Provider Demographics
NPI:1770509119
Name:WHEAT, MARY POLLY E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY POLLY
Middle Name:E
Last Name:WHEAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5733
Mailing Address - Country:US
Mailing Address - Phone:516-825-4431
Mailing Address - Fax:
Practice Address - Street 1:60 HAVEN AVE
Practice Address - Street 2:STUDENT HEALTH SERVICE - CUMC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2604
Practice Address - Country:US
Practice Address - Phone:212-305-3400
Practice Address - Fax:212-342-3955
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162230207R00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF21260Medicare UPIN