Individual
MICHELLE POLYAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
801 LEXINGTON AVE APT 4A, LAKEWOOD, NJ 08701-2861
(610) 715-6567
Mailing address
801 LEXINGTON AVE APT 4A, LAKEWOOD, NJ 08701-2861
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00875900
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
12/13/2022
Last updated
11/11/2024
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