Provider Demographics
NPI:1801865423
Name:POLLACK, BONNIE JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:JOAN
Last Name:POLLACK
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 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 428
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3808
Mailing Address - Country:US
Mailing Address - Phone:516-663-2066
Mailing Address - Fax:516-663-4655
Practice Address - Street 1:222 STATION PLZ N
Practice Address - Street 2:SUITE 428
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3808
Practice Address - Country:US
Practice Address - Phone:516-663-2066
Practice Address - Fax:516-663-4655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209038207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01792341Medicaid
G26407Medicare UPIN
735471Medicare ID - Type Unspecified