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NPI Code Detail

MEDICARE: DR. DIANNE MARIE POLOWCZYK PH.D.

MEDICARE: DR. DIANNE MARIE POLOWCZYK PH.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
1103T00000XPsychologist8265NY
2103TA0700XAdult Development & Aging Psychologist8265NY
3103TB0200XCognitive & Behavioral Psychologist8265NY
4103TC0700XClinical Psychologist8265NY
5103TC2200XClinical Child & Adolescent Psychologist8265NY
6103TF0000XFamily Psychologist8265NY
7103TH0004XHealth Psychologist8265NY
8103TP2701XGroup Psychotherapy Psychologist8265NY

General Provider Information

NPI Number : 1528267069
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANNE MARIE POLOWCZYK PH.D.
Provider Business Mailing Address
First Line : 20 MEADOWWOOD CT
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-3829
Country : US
Telephone Number : 631-271-6810
Fax Number : 631-271-9783
Provider Business Practice Location Address
First Line : 20 MEADOWWOOD CT
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-3829
Country : US
Telephone Number : 631-271-6810
Fax Number : 631-271-9783
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2007
Last Update Date : 07/14/2007

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