1902862691 NPI number — DR. BERNARD POLATSCH MD

Table of content: DR. BERNARD POLATSCH MD (NPI 1902862691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902862691 NPI number — DR. BERNARD POLATSCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLATSCH
Provider First Name:
BERNARD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902862691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 SOUTH OYSTER BAY ROAD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
HICKSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-931-4800
Provider Business Mailing Address Fax Number:
516-931-7241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SOUTH OYSTER BAY ROAD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
HICKSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-931-4800
Provider Business Practice Location Address Fax Number:
516-931-7241
Provider Enumeration Date:
04/22/2006

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: 207V00000X , with the licence number:  091685 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11817 . This is a "VYTRA GYN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 091685B73 . This is a "HEALTHFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62186305 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1C8118 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 529551 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0047975 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 529551 . This is a "MDNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6403684 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91154 . This is a "USH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4233993 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 553291 . This is a "HERITAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AP196 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106274 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 529552 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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