Basic Information
| Provider Information | |||||||||
| NPI: | 1467715839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLISHCHUK | ||||||||
| FirstName: | ROMAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 49TH ST | ||||||||
| Address2: | MEDICAL & SURGICAL EYESITE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112192922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182838000 | ||||||||
| FaxNumber: | 7183653655 | ||||||||
| Practice Location | |||||||||
| Address1: | 904 49TH ST | ||||||||
| Address2: | MEDICAL & SURGICAL EYESITE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112192922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182838000 | ||||||||
| FaxNumber: | 7183653655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2012 | ||||||||
| LastUpdateDate: | 11/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 007870 | NY | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.