Provider Demographics
NPI:1790719615
Name:GILCHYONOK, POLINA (MD)
Entity Type:Individual
Prefix:DR
First Name:POLINA
Middle Name:
Last Name:GILCHYONOK
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 1:31 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538
Mailing Address - Country:US
Mailing Address - Phone:914-523-0451
Mailing Address - Fax:914-630-7314
Practice Address - Street 1:31 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538
Practice Address - Country:US
Practice Address - Phone:914-523-0451
Practice Address - Fax:914-630-7314
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01507088Medicaid
NY01507088Medicaid
F90215Medicare UPIN
NY29J141Medicare ID - Type Unspecified