Healthcare Provider Details

I. General information

NPI: 1174020093
Provider Name (Legal Business Name): CHAVA POLLAK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 EDISON CT
MONSEY NY
10952-1938
US

IV. Provider business mailing address

40 S MAIN ST STE 1300
MEMPHIS TN
38103-5513
US

V. Phone/Fax

Practice location:
  • Phone: 845-499-7985
  • Fax:
Mailing address:
  • Phone: 901-422-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: