Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MA45959 | NJ |
NPI | 1407851355 |
---|---|
Provider Name | Dr. Donald R. Polakoff |
First Address | Monroe, NJ 08831-6000 |
Second Address | Monroe, NJ 08831-6000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D19781 | (02) | NJ |