Provider Demographics
NPI:1780668061
Name:POLASHENSKI, EDWARD STANLEY (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:STANLEY
Last Name:POLASHENSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:128 W 14TH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-3266
Practice Address - Country:US
Practice Address - Phone:570-455-7677
Practice Address - Fax:570-455-7627
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05004597L207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010140830002Medicaid
PA060548OtherFPH
PA182462Medicare ID - Type Unspecified
PA0010140830002Medicaid
PA182462YCWMedicare PIN