Provider Demographics
NPI:1942381884
Name:POLLACK, WENDY K (NP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:K
Last Name:POLLACK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-5858
Mailing Address - Fax:631-444-1899
Practice Address - Street 1:181 N BELLE MEAD RD STE 2
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3495
Practice Address - Country:US
Practice Address - Phone:631-444-5858
Practice Address - Fax:631-444-1899
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330972363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP16474Medicare UPIN
NY96N971Medicare ID - Type Unspecified