MEDICARE: MR. ANATOLY POLOSATKIN DO

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	207R00000X	Internal Medicine Physician	OS19678	FL
2	207R00000X	Internal Medicine Physician	25MB08051300	NJ
3	207R00000X	Internal Medicine Physician	230799	NY
4	207R00000X	Internal Medicine Physician	OS013476	PA

General Provider Information

NPI Number	:	1376549923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANATOLY POLOSATKIN DO

Provider Business Mailing Address
First Line	:	2693 FALLOW HILL LN
Second Line	:
City	:	JAMISON
State	:	PA
Zip	:	18929-1770
Country	:	US
Telephone Number	:	718-904-6605
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 EASTCHESTER RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2301
Country	:	US
Telephone Number	:	718-904-2400
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	04/09/2023

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