Provider Demographics
NPI:1861606709
Name:POLLACK, MARK STEVEN (LPN)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEVEN
Last Name:POLLACK
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SHERMAN AVE
Mailing Address - Street 2:APT E8
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10568-5662
Mailing Address - Country:US
Mailing Address - Phone:914-739-5582
Mailing Address - Fax:
Practice Address - Street 1:305 SHERMAN AVE
Practice Address - Street 2:APT E8
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10568-5662
Practice Address - Country:US
Practice Address - Phone:914-739-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2860211164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse