Provider Demographics
NPI:1861688251
Name:MICHAEL POLCINO MD PC
Entity Type:Organization
Organization Name:MICHAEL POLCINO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-321-1045
Mailing Address - Street 1:141 LITTLE EAST NECK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7719
Mailing Address - Country:US
Mailing Address - Phone:631-321-1045
Mailing Address - Fax:631-321-1102
Practice Address - Street 1:141 LITTLE EAST NECK RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7719
Practice Address - Country:US
Practice Address - Phone:631-321-1045
Practice Address - Fax:631-321-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136866207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEW901Medicare PIN