Healthcare Provider Details

I. General information

NPI: 1801867783
Provider Name (Legal Business Name): DR. RICHARD POLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS 3959 BROADWAY
NEW YORK NY
10032
US

IV. Provider business mailing address

276 LYDECKER ST
ENGLEWOOD NJ
07631-1913
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-7250
  • Fax: 212-544-1974
Mailing address:
  • Phone: 201-227-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number114861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: