Provider Demographics
NPI:1336177054
Name:POLLACK, JEFFREY STUART (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STUART
Last Name:POLLACK
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 1:6044 HARDING HWY
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-1530
Mailing Address - Country:US
Mailing Address - Phone:609-625-9146
Mailing Address - Fax:609-625-7405
Practice Address - Street 1:6044 HARDING HWY
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-1530
Practice Address - Country:US
Practice Address - Phone:609-625-9146
Practice Address - Fax:609-625-7405
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA44557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58494Medicare UPIN
NJ570246Medicare ID - Type Unspecified