Provider Demographics
NPI:1023109121
Name:POLLOCK, ROGER GERARD (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:GERARD
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ACKERMAN RD
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2602
Mailing Address - Country:US
Mailing Address - Phone:201-934-7026
Mailing Address - Fax:
Practice Address - Street 1:1 W RIDGEWOOD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-612-9774
Practice Address - Fax:201-612-0103
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168100-2207X00000X
NJ25MA05804400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNS1241OtherOXFORD HEALTH PLANS
NJF49346Medicare UPIN
NJ034207Medicare ID - Type Unspecified
NY62K591Medicare ID - Type Unspecified