Healthcare Provider Details

I. General information

NPI: 1497047831
Provider Name (Legal Business Name): JEFFREY S. POLLACK, MD., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6044 HARDING HWY
MAYS LANDING NJ
08330-1549
US

IV. Provider business mailing address

6044 HARDING HWY
MAYS LANDING NJ
08330-1549
US

V. Phone/Fax

Practice location:
  • Phone: 609-625-9146
  • Fax: 609-625-7405
Mailing address:
  • Phone: 609-625-9146
  • Fax: 609-625-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA44557
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMA44557
License Number StateNJ

VIII. Authorized Official

Name: JEFFREY STUART POLLACK
Title or Position: PRESIDENT
Credential: MD
Phone: 609-625-9146