Provider Demographics
NPI:1831329523
Name:POLONSKY-RAGOVIN PC
Entity type:Organization
Organization Name:POLONSKY-RAGOVIN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:C
Authorized Official - Last Name:POLONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-566-7508
Mailing Address - Street 1:185 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2338
Mailing Address - Country:US
Mailing Address - Phone:617-566-7508
Mailing Address - Fax:
Practice Address - Street 1:185 NEWTON ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2338
Practice Address - Country:US
Practice Address - Phone:617-566-7508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37465103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty