1558316711 NPI number — HARRY STEVEN POLSKY M.D.

Table of content: HARRY STEVEN POLSKY M.D. (NPI 1558316711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558316711 NPI number — HARRY STEVEN POLSKY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLSKY
Provider First Name:
HARRY
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1558316711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500-8735
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-8735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-456-7000
Provider Business Mailing Address Fax Number:
215-254-2599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 W GERMANTOWN PIKE
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
EAST NORRITON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19403-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-622-7100
Provider Business Practice Location Address Fax Number:
484-622-7121
Provider Enumeration Date:
05/24/2006

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: 2086S0129X , with the licence number:  MD012653E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000718273 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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