MEDICARE: H JONATHAN POLAN MD

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	2084P0800X	Psychiatry Physician	144646	NY

General Provider Information

NPI Number	:	1992893267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	H JONATHAN POLAN MD

Provider Business Mailing Address
First Line	:	1225 PARK AVE
Second Line	:	SUITE 1S
City	:	NEW YORK
State	:	NY
Zip	:	10128-1758
Country	:	US
Telephone Number	:	347-501-2010
Fax Number	:	646-530-8427

Provider Business Practice Location Address
First Line	:	1225 PARK AVE
Second Line	:	SUITE 1S
City	:	NEW YORK
State	:	NY
Zip	:	10128-1758
Country	:	US
Telephone Number	:	347-501-2010
Fax Number	:	646-530-8427

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	01/29/2015

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