Provider Demographics
NPI:1144457417
Name:KORIK, POLINA TOKAR (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:POLINA
Middle Name:TOKAR
Last Name:KORIK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2131
Mailing Address - Country:US
Mailing Address - Phone:201-965-9695
Mailing Address - Fax:
Practice Address - Street 1:78 1ST AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2131
Practice Address - Country:US
Practice Address - Phone:201-965-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019169-1235Z00000X
NJ41YS00603400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist