MEDICARE: MEDICAL OFFICE OF DOCTOR ILONA K POLAK PC

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	NY

General Provider Information

NPI Number	:	1699058958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL OFFICE OF DOCTOR ILONA K POLAK PC

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	:	631-808-3338

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	:	631-808-3338

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS ILONA K POLAK
Credential	:	M.D.
Telephone Number	:	631-727-6284

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	01/19/2015

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