Provider Demographics
NPI:1982850624
Name:POLINA LISS MD PLLC
Entity Type:Organization
Organization Name:POLINA LISS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-477-1325
Mailing Address - Street 1:305 SECOND AVENUE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-477-1325
Mailing Address - Fax:
Practice Address - Street 1:305 2ND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2739
Practice Address - Country:US
Practice Address - Phone:212-477-1325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH03278Medicare UPIN
NYA100000141Medicare PIN