MEDICARE: BARNABAS POLEON

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	174400000X	Specialist

General Provider Information

NPI Number	:	1780945709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARNABAS POLEON

Provider Business Mailing Address
First Line	:	1514 SEDGWICK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-6631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 SEDGWICK AVE APT 9B
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-6633
Country	:	US
Telephone Number	:	646-851-5846
Fax Number	:

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	06/06/2012

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Directions to “ BARNABAS POLEON ” Practice Location

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