Provider Demographics
NPI:1750708236
Name:POLLACK, MI CHUNG DIANE (FNP)
Entity type:Individual
Prefix:
First Name:MI CHUNG DIANE
Middle Name:
Last Name:POLLACK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MT SINAI URGENT CARE
Mailing Address - Street 2:638 COLUMBUS AVE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-828-3250
Mailing Address - Fax:
Practice Address - Street 1:MT SINAI URGENT CARE
Practice Address - Street 2:638 COLUMBUS AVE
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-828-3250
Practice Address - Fax:212-828-3297
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily