Provider Demographics
NPI:1932217304
Name:PODOLSKY, MORRIS M (MD)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:M
Last Name:PODOLSKY
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 1:41 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3400
Mailing Address - Country:US
Mailing Address - Phone:212-684-4747
Mailing Address - Fax:212-684-1377
Practice Address - Street 1:41 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3400
Practice Address - Country:US
Practice Address - Phone:212-684-4747
Practice Address - Fax:212-684-1377
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128083207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01340725Medicaid
NY24A251Medicare PIN
NYB11345Medicare UPIN