Provider Demographics
NPI:1912759143
Name:POLLACK, ANDREW ELI (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ELI
Last Name:POLLACK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LAKEVILLE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1103
Mailing Address - Country:US
Mailing Address - Phone:516-354-3401
Mailing Address - Fax:
Practice Address - Street 1:410 LAKEVILLE RD STE 204
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1103
Practice Address - Country:US
Practice Address - Phone:516-354-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty