Provider Demographics
NPI:1144553025
Name:VASCULAR INTERVENTIONAL SERVICES, PLLC
Entity type:Organization
Organization Name:VASCULAR INTERVENTIONAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-476-9100
Mailing Address - Street 1:1110B HALLOCK AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1210
Mailing Address - Country:US
Mailing Address - Phone:631-476-9100
Mailing Address - Fax:631-476-4919
Practice Address - Street 1:1110B HALLOCK AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STA
Practice Address - State:NY
Practice Address - Zip Code:11776-1210
Practice Address - Country:US
Practice Address - Phone:631-476-9100
Practice Address - Fax:631-476-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1931002086S0129X
NY2217082086S0129X
NY0995742086S0129X
NY1863402086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty