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General NPI Number Information
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NPI Number | 1699058958
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Entity Type | Organization
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Legal Business Name | MEDICAL OFFICE OF DOCTOR ILONA K POLAK PC
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 01/19/2015
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Provider Practice Location Address
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Address Line | 34 BAY ST # 103
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City | SAG HARBOR
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State | NY
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Zip | 11963-3104
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Country | US
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Telephone | 631-808-3337
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Fax | 631-808-3338
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Provider Business Mailing Address
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Address Line | PO BOX 2986
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City | SAG HARBOR
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State | NY
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Zip | 11963-0402
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Country | US
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Telephone | 631-808-3337
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Fax | 631-808-3338
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS ILONA K POLAK
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Credential | M.D.
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Telephone | 631-727-6284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 245282
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License Number State | NY
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