1982607628 NPI number — WAYNE M POLLAK MD

Table of content: WAYNE M POLLAK MD (NPI 1982607628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982607628 NPI number — WAYNE M POLLAK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLLAK
Provider First Name:
WAYNE
Provider Middle Name:
M
Provider Name Prefix Text:
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:
1982607628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 CORPORATE WAY
Provider Second Line Business Mailing Address:
DOOR D
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33025-3925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-276-5685
Provider Business Mailing Address Fax Number:
954-985-7074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20803 BISCAYNE BLVD STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-265-7900
Provider Business Practice Location Address Fax Number:
954-276-0263
Provider Enumeration Date:
05/26/2005

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: 207RC0000X , with the licence number:  ME76843 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 264751600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com