Healthcare Provider Details

I. General information

NPI: 1619405644
Provider Name (Legal Business Name): EMILY POLLACK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 KINNELON RD RM 28
KINNELON NJ
07405-2351
US

IV. Provider business mailing address

170 KINNELON RD RM 28A
KINNELON NJ
07405-2351
US

V. Phone/Fax

Practice location:
  • Phone: 973-838-1717
  • Fax: 973-838-1775
Mailing address:
  • Phone: 973-838-0001
  • Fax: 973-838-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA10829400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA10829400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA10829400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: