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General NPI Number Information
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NPI Number | 1831329523
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Entity Type | Organization
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Legal Business Name | POLONSKY-RAGOVIN PC
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 185 NEWTON ST
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City | WESTON
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State | MA
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Zip | 02493-2338
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Country | US
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Telephone | 617-566-7508
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Fax |
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Provider Business Mailing Address
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Address Line | 185 NEWTON ST
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City | WESTON
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State | MA
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Zip | 02493-2338
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Country | US
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Telephone | 617-566-7508
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEREK C POLONSKY
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Credential | MD
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Telephone | 617-566-7508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 37465
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License Number State | MA
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