Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 46031 | MA |
NPI | 1467562868 |
---|---|
Provider Name | Joseph F Polak |
First Address | Boston, MA 02119-2560 |
Second Address | Boston, MA 02111-1526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 30/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110043641A | (05) | MA |
E10388 | (02) | MA |