Provider Demographics
NPI:1013936137
Name:POLATAIKO, NADIA (MD)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:POLATAIKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TWO MILE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6618
Mailing Address - Country:US
Mailing Address - Phone:716-447-6450
Mailing Address - Fax:716-447-6486
Practice Address - Street 1:300 TWO MILE CREEK RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-6618
Practice Address - Country:US
Practice Address - Phone:716-447-6450
Practice Address - Fax:716-447-6486
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0410830OtherINDEPENDENT HEATLH
NY040426001692OtherFIDELIS
NY110194636OtherRAILROAD MEDICARE
NY00020529501OtherUNIVERA
NY000525759001OtherBLUE CROSS OF WNY
NY0410830OtherINDEPENDENT HEATLH
NYBB7144Medicare ID - Type UnspecifiedMEDICARE PART B