Provider Demographics
NPI:1891192530
Name:POLLACK, ALEX MITCHELL (LMT)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:MITCHELL
Last Name:POLLACK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 RICHMOND BLVD
Mailing Address - Street 2:#3A
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779
Mailing Address - Country:US
Mailing Address - Phone:631-585-2832
Mailing Address - Fax:
Practice Address - Street 1:34 RICHMOND BLVD
Practice Address - Street 2:#3A
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779
Practice Address - Country:US
Practice Address - Phone:516-816-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3897225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist