Provider Demographics
NPI:1740267509
Name:POLACHEK, ROBERT S (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:POLACHEK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-472-8060
Practice Address - Street 1:4652 NIXON PARK DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9700
Practice Address - Country:US
Practice Address - Phone:315-492-3403
Practice Address - Fax:315-492-2960
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-05-12
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Provider Licenses
StateLicense IDTaxonomies
NY150899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB81409Medicare UPIN
NY080067468Medicare PIN
NY55290OMedicare PIN