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General NPI Number Information
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NPI Number | 1659750560
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Entity Type | Individual
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Provider Name | JONATHAN POLAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 12/14/2025
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Provider Practice Location Address
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Address Line | 55 MILL ST STE 101
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City | WOLFEBORO
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State | NH
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Zip | 03894-4328
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Country | US
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Telephone | 603-697-7047
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Fax |
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Provider Business Mailing Address
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Address Line | 17909 SOLEDAD CANYON RD # 100
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City | SANTA CLARITA
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State | CA
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Zip | 91387-3210
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Country | US
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Telephone | 661-367-3500
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Fax | 661-367-3539
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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 | 19473
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C194706
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License Number State | CA
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