Healthcare Provider Details

I. General information

NPI: 1578530010
Provider Name (Legal Business Name): NOHA POLACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3196 KENNEDY BLVD THIRD FLOOR
UNION CITY NJ
07087-2436
US

IV. Provider business mailing address

3196 KENNEDY BLVD THIRD FLOOR
UNION CITY NJ
07087-2436
US

V. Phone/Fax

Practice location:
  • Phone: 201-319-9800
  • Fax: 201-319-9849
Mailing address:
  • Phone: 201-319-9800
  • Fax: 201-319-9849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA63880
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier1K0951N
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHEALTHNET OF NORTHEAST
# 2
Identifier559531
Identifier TypeOTHER
Identifier StateNY
Identifier Issuer559531
# 3
IdentifierP1237291
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerOXFORD HEALTHCARE
# 4
IdentifierJ6791
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHORIZON BCBSNJ
# 5
Identifier1086830
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHORIZON NJ HEATHCARE
# 6
Identifier2602850
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGHI
# 7
Identifier1771005
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerCIGNA HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: