MEDICARE: YSALBA POLANCO FABIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	LA-1946180	NY

General Provider Information

NPI Number	:	1043172810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YSALBA POLANCO FABIAN

Provider Business Mailing Address
First Line	:	857 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3106
Country	:	US
Telephone Number	:	347-479-5833
Fax Number	:

Provider Business Practice Location Address
First Line	:	857 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3106
Country	:	US
Telephone Number	:	347-479-5833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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