Provider Demographics
NPI:1841385622
Name:POLANSKY, NORMAN DAVID (PHD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:DAVID
Last Name:POLANSKY
Suffix:
Gender:M
Credentials:PHD
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 3133
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-9133
Mailing Address - Country:US
Mailing Address - Phone:201-666-1130
Mailing Address - Fax:201-666-4313
Practice Address - Street 1:2083 CENTER AVE
Practice Address - Street 2:SUITE G
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-9133
Practice Address - Country:US
Practice Address - Phone:201-666-1130
Practice Address - Fax:201-666-4313
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100191900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P0442691Medicare ID - Type Unspecified