Healthcare Provider Details

I. General information

NPI: 1558355347
Provider Name (Legal Business Name): BRIAN POLLACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GERMANTOWN RD SUITE 2B
DANBURY CT
06810-5013
US

IV. Provider business mailing address

1305 POST RD
FAIRFIELD CT
06824-6016
US

V. Phone/Fax

Practice location:
  • Phone: 203-794-0090
  • Fax: 203-830-4614
Mailing address:
  • Phone: 203-292-2000
  • Fax: 203-255-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number32835
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number032835
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: