Healthcare Provider Details

I. General information

NPI: 1710372628
Provider Name (Legal Business Name): DIJANA POLJAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVENUE, BOX 626
ROCHESTER NY
14642
US

IV. Provider business mailing address

601 ELMWOOD AVENUE, BOX 626
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-3191
  • Fax: 585-273-3637
Mailing address:
  • Phone: 585-275-3191
  • Fax: 585-273-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2019005178
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number334687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: