Organization
DEAN C POLISTINA MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEAN C POLISTINA MD (SOLE MEMBER)
(212) 957-6933
Entity
Organization
Contact information
Practice address
200 W 57TH ST, SUITE 1410, NEW YORK, NY 10019-3211
(212) 957-6933
(212) 957-3477
Mailing address
200 W 57TH ST, SUITE 1410, NEW YORK, NY 10019-3211
(212) 957-6933
(212) 957-3477
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
193200
NY
Other
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
Enumeration date
02/23/2012
Last updated
02/23/2012
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