Provider Demographics
NPI:1063209674
Name:POLANSKI, PHILLIP B
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:B
Last Name:POLANSKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 E AND WEST RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3728
Mailing Address - Country:US
Mailing Address - Phone:716-473-3950
Mailing Address - Fax:
Practice Address - Street 1:175 HEIM RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-1353
Practice Address - Country:US
Practice Address - Phone:716-626-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY837298163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool