Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | MT194363 | PA |
Y | 208000000X | Pediatrician | MD435420 | PA |
NPI | 1033445614 |
---|---|
Provider Name | Nina M Poliak |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Allentown, PA 18102-3648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2009 |
Last Update Date | 19/10/2016 |