MEDICARE: MISS ILONA KATARZYNA POLAK M.D.

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	207Q00000X	Family Medicine Physician	245282-1	NY

General Provider Information

NPI Number	:	1346432077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ILONA KATARZYNA POLAK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2986
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-0402
Country	:	US
Telephone Number	:	631-808-3337
Fax Number	:	631-808-3339

Provider Business Practice Location Address
First Line	:	34 BAY ST # 103
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-3104
Country	:	US
Telephone Number	:	631-808-3337
Fax Number	:	631-808-3339

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	03/24/2021

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