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General NPI Number Information
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NPI Number | 1487273926
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Entity Type | Individual
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Provider Name | YANERIS ALTAGRACIA SUERO POLANCO MD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 199 CHERRY ST
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City | MILFORD
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State | CT
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Zip | 06460-3501
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Country | US
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Telephone | 203-874-2543
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Fax | 203-874-2544
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Provider Business Mailing Address
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Address Line | 1181 TINTON AVE APT 1C
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City | BRONX
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State | NY
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Zip | 10456-5464
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Country | US
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Telephone | 347-358-5542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 102156-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 79118
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License Number State | CT
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