Healthcare Provider Details

I. General information

NPI: 1871560268
Provider Name (Legal Business Name): LAURIE POLIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 CROSBY ST
NEW YORK NY
10012-4410
US

IV. Provider business mailing address

62 CROSBY ST
NEW YORK NY
10012-4410
US

V. Phone/Fax

Practice location:
  • Phone: 212-431-1600
  • Fax: 212-431-7521
Mailing address:
  • Phone: 212-431-1600
  • Fax: 212-431-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberNY165531
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number165531
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number165531
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number165531
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number165531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: