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General NPI Number Information
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NPI Number | 1720362833
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Entity Type | Individual
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Provider Name | ERIC POLLAK
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Gender | Male
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 24302 NORTHERN BLVD
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City | DOUGLASTON
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State | NY
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Zip | 11362-1150
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Country | US
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Telephone | 718-423-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 15040 JEWEL AVE APT 66A
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City | FLUSHING
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State | NY
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Zip | 11367-1434
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Country | US
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Telephone | 718-440-7232
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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