MEDICARE: POLSAK CORPORATION

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	3336C0003X	Community/Retail Pharmacy	028262	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
2	2058490	OTHER		PK

General Provider Information

NPI Number	:	1720099377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLSAK CORPORATION

Provider Business Mailing Address
First Line	:	1018 OGDEN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-5103
Country	:	US
Telephone Number	:	718-538-8183
Fax Number	:	718-538-2855

Provider Business Practice Location Address
First Line	:	1018 OGDEN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-5103
Country	:	US
Telephone Number	:	718-538-8183
Fax Number	:	718-538-2855

Authorized Official
Title or Position	:	PHRMD
Name	:	KUNAL SHAH
Credential	:
Telephone Number	:	718-538-8183

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	12/06/2016

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Directions to “POLSAK CORPORATION ” Practice Location

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