Provider Demographics
NPI:1639056682
Name:POLTER, REFAEL YEHUDAH
Entity type:Individual
Prefix:MR
First Name:REFAEL
Middle Name:YEHUDAH
Last Name:POLTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5330
Mailing Address - Country:US
Mailing Address - Phone:248-872-8610
Mailing Address - Fax:
Practice Address - Street 1:667 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3310
Practice Address - Country:US
Practice Address - Phone:718-774-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool