Healthcare Provider Details

I. General information

NPI: 1134328495
Provider Name (Legal Business Name): JENNIFER POLLAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 SHERIDAN ST SUITE 201
HOLLYWOOD FL
33021-3567
US

IV. Provider business mailing address

4340 SHERIDAN ST SUITE 201
HOLLYWOOD FL
33021-3567
US

V. Phone/Fax

Practice location:
  • Phone: 954-989-9998
  • Fax: 954-989-9979
Mailing address:
  • Phone: 954-989-9998
  • Fax: 954-989-9979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME77220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: