MEDICARE: STEPHANIE ALICE POLLITZ 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	207V00000X	Obstetrics & Gynecology Physician	2196801	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558362053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ALICE POLLITZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 32577
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06150-2577
Country	:	US
Telephone Number	:	201-804-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1090 AMSTERDAM AVE
Second Line	:	STE 6A
City	:	NEW YORK
State	:	NY
Zip	:	10025-1737
Country	:	US
Telephone Number	:	212-523-5179
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/21/2012

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