MEDICARE: DR. MI CHUNG DIANE POLLACK DNP-BC

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	363LF0000X	Family Nurse Practitioner	016434	CT
2	363LF0000X	Family Nurse Practitioner	338631	NY

General Provider Information

NPI Number	:	1750708236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MI CHUNG DIANE POLLACK DNP-BC

Provider Business Mailing Address
First Line	:	MEDRITE URGENT CARE
Second Line	:	54 WEST 225TH ST.
City	:	BRONX
State	:	NY
Zip	:	10463
Country	:	US
Telephone Number	:	718-568-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 W 225TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-7002
Country	:	US
Telephone Number	:	718-568-8222
Fax Number	:

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

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	02/03/2026

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