Healthcare Provider Details

I. General information

NPI: 1194485086
Provider Name (Legal Business Name): DR. KAREN SHULAMIS POLLAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAAPELEI EGOZ 12 BET APT 1
BEIT SHEMESH ISRAEL
99999
IL

IV. Provider business mailing address

275 MAPLE ST
WEST HEMPSTEAD NY
11552-3203
US

V. Phone/Fax

Practice location:
  • Phone: 53-524-1948
  • Fax:
Mailing address:
  • Phone: 551-404-5734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019905-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: