Healthcare Provider Details

I. General information

NPI: 1689915357
Provider Name (Legal Business Name): TAMARA BETH POLLAK WHNP (PREVIOUSLY RN)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83-21 57TH AVE
ELMHURST NY
11373
US

IV. Provider business mailing address

83-21 57TH AVE,
ELMHURST NY
11373
US

V. Phone/Fax

Practice location:
  • Phone: 718-898-1170
  • Fax: 718-898-3190
Mailing address:
  • Phone: 718-898-1170
  • Fax: 718-898-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421135
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number485415
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: