Healthcare Provider Details

I. General information

NPI: 1558899971
Provider Name (Legal Business Name): ILANA GELFOND POLNARIEV OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 HYLAN BLVD STE 1BC
STATEN ISLAND NY
10312-6507
US

IV. Provider business mailing address

4300 HYLAN BLVD STE 1BC
STATEN ISLAND NY
10312-6507
US

V. Phone/Fax

Practice location:
  • Phone: 718-481-2020
  • Fax: 844-464-7404
Mailing address:
  • Phone: 718-481-2020
  • Fax: 844-464-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0065888
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number006588
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number006588
License Number StateNY

VIII. Authorized Official

Name: DR. ILANA GELFOND-POLNARIEV
Title or Position: OWNER
Credential: OD
Phone: 718-481-2020