1306837323 NPI number — MS. JO-ANN BERGERON POLSKY BS, MPH, RD

Table of content: MS. JO-ANN BERGERON POLSKY BS, MPH, RD (NPI 1306837323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306837323 NPI number — MS. JO-ANN BERGERON POLSKY BS, MPH, RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLSKY
Provider First Name:
JO-ANN
Provider Middle Name:
BERGERON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BS, MPH, RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERGERON
Provider Other First Name:
JO-ANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306837323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
593 EDDY ST
Provider Second Line Business Mailing Address:
RHODE ISLAND HOSPITAL POB 334
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-4923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-444-4422
Provider Business Mailing Address Fax Number:
401-444-4416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
593 EDDY ST
Provider Second Line Business Practice Location Address:
RHODE ISLAND HOSPITAL POB 334
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-4923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-444-4422
Provider Business Practice Location Address Fax Number:
401-444-4416
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X , with the licence number:  LDN00151 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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