Healthcare Provider Details

I. General information

NPI: 1083863344
Provider Name (Legal Business Name): ROGER POLISH P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CALLE SANTA CRUZ INSTITUTO SAN PABLO, SUITE 502
BAYAMON PR
00961-7041
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX PMB 351
GUAYNABO PR
00966-2715
US

V. Phone/Fax

Practice location:
  • Phone: 787-778-0632
  • Fax: 787-778-3720
Mailing address:
  • Phone: 787-778-0632
  • Fax: 787-778-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number15803
License Number StatePR

VIII. Authorized Official

Name: ROGER DAVID POLISH
Title or Position: GASTROENTEROLOGIST
Credential: MD
Phone: 787-778-0632