Healthcare Provider Details

I. General information

NPI: 1013508498
Provider Name (Legal Business Name): LAUREN ARIEL POLAKOFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 SAW MILL RD
NEW CITY NY
10956-2310
US

IV. Provider business mailing address

62 SAW MILL RD
NEW CITY NY
10956-2310
US

V. Phone/Fax

Practice location:
  • Phone: 954-825-1502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11690
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number026357
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number68910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: