MEDICARE: DR. AMY ELLEN POLLACK MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	184149	NY

General Provider Information

NPI Number	:	1619304516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY ELLEN POLLACK MD, MPH

Provider Business Mailing Address
First Line	:	529 WEST 42 STREET
Second Line	:	SUITE 7G
City	:	NEW YORK
State	:	NY
Zip	:	10036-6229
Country	:	US
Telephone Number	:	917-597-3851
Fax Number	:	212-244-0976

Provider Business Practice Location Address
First Line	:	529 WEST 42 STREET
Second Line	:	SUITE 7G
City	:	NEW YORK
State	:	NY
Zip	:	10036-6229
Country	:	US
Telephone Number	:	917-597-3851
Fax Number	:	212-244-0976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2013
Last Update Date	:	10/09/2013

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