Organization
EDWARD S POLASHENSKI DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD S POLASHENSKI DO FACOI (PRESIDENT)
(570) 455-7677
Entity
Organization
Contact information
Practice address
128 WEST 14TH ST, HAZLETON, PA 18201-3266
(570) 455-7677
(570) 455-7627
Mailing address
128 W 14TH ST, HAZLETON, PA 18201-3266
(570) 455-7677
(570) 455-7627
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD 031594 E
—
207R00000X
Internal Medicine Physician
OS 004597 L
—
207RG0100X
Gastroenterology Physician
MD 031594 E
—
207RG0100X
Gastroenterology Physician
Primary
OS 004597 L
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010140830002
—
PA
05
—
0010850580001
—
PA
01
—
122500
BLUE SHIELD
PA
01
—
182462
BLUE SHIELD
PA
Enumeration date
02/12/2007
Last updated
06/20/2008
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