Healthcare Provider Details

I. General information

NPI: 1528625910
Provider Name (Legal Business Name): ALI POLSKY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 EASTON AVE
BETHLEHEM PA
18017-4204
US

IV. Provider business mailing address

2310 9TH AVE N
ST PETERSBURG FL
33713-6833
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-3555
  • Fax:
Mailing address:
  • Phone: 305-215-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT019004
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: