Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 186340 | NY |
NPI | 1013988088 |
---|---|
Provider Name | Dr. Robert M Pollina |
First Address | Port Jefferson Station, NY 11776-1210 |
Second Address | Port Jefferson Station, NY 11776-1210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 01/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01658882 | (05) | NY |
F75798 | (02) | NY |