Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | NYS092664 | NY |
NPI | 1467538298 |
---|---|
Provider Name | Stuart Barry Polisner |
First Address | Commack, NY 11725-3412 |
Second Address | Commack, NY 11725-3412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |