Healthcare Provider Details

I. General information

NPI: 1982949715
Provider Name (Legal Business Name): TALIA RUTH POLLAK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144-28 72ND AVE
FLUSHING NY
11367
US

IV. Provider business mailing address

14428 72ND AVE
FLUSHING NY
11367-2402
US

V. Phone/Fax

Practice location:
  • Phone: 718-440-7784
  • Fax:
Mailing address:
  • Phone: 718-440-7784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number63 017754
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: