Healthcare Provider Details

I. General information

NPI: 1386979490
Provider Name (Legal Business Name): PAUL POLLICHINO C.O.,P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 SUNNYSIDE BLVD SUITE 207
PLAINVIEW NY
11803-1591
US

IV. Provider business mailing address

88 SUNNYSIDE BLVD SUITE 207
PLAINVIEW NY
11803-1591
US

V. Phone/Fax

Practice location:
  • Phone: 516-576-6114
  • Fax: 516-576-6115
Mailing address:
  • Phone: 516-576-6114
  • Fax: 516-576-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: