# DEAN C POLISTINA MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104190065
- **Authorized official:** DR. DEAN C POLISTINA MD (SOLE MEMBER)
- **Authorized official phone:** (212) 957-6933

## Contact information

- **Practice address:** 200 W 57TH ST, SUITE 1410, NEW YORK, NY 10019-3211
- **Practice address phone:** (212) 957-6933
- **Practice address fax:** (212) 957-3477
- **Mailing address:** 200 W 57TH ST, SUITE 1410, NEW YORK, NY 10019-3211
- **Mailing address phone:** (212) 957-6933
- **Mailing address fax:** (212) 957-3477

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 193200 | NY | Yes |

## Other

- **Enumeration date:** 02/23/2012
- **Last updated:** 02/23/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01636277 | — | NY |
| 01 | — | 06416 | BC/BS | NY |
| 01 | — | 5598510 | AETNA | NY |
| 01 | — | P535102 | OXFORD | NY |
| 01 | — | PRIS 31763P | HIP | NY |