Provider Demographics
NPI:1730192071
Name:POLOMSKY, MAREK (MD)
Entity type:Individual
Prefix:DR
First Name:MAREK
Middle Name:
Last Name:POLOMSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 IRVING AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:154-646-2559
Mailing Address - Fax:315-464-6251
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 640
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:154-646-2559
Practice Address - Fax:315-464-6251
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245212208G00000X
NJMA09512700208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY245212Medicaid