Basic Information
| Provider Information | |||||||||
| NPI: | 1487273926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUERO POLANCO | ||||||||
| FirstName: | YANERIS | ||||||||
| MiddleName: | ALTAGRACIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1181 TINTON AVE APT 1C | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104565464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473585542 | ||||||||
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| Practice Location | |||||||||
| Address1: | 374 STOCKHOLM ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112374006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189637272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2020 | ||||||||
| LastUpdateDate: | 04/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 102156-01 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.