Provider Demographics
NPI:1063407211
Name:POLIAK, JOSE (MD,PA)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:POLIAK
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 COLONIAL DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5682
Mailing Address - Country:US
Mailing Address - Phone:954-979-8770
Mailing Address - Fax:954-969-9097
Practice Address - Street 1:5800 COLONIAL DR
Practice Address - Street 2:SUITE 306
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5682
Practice Address - Country:US
Practice Address - Phone:954-979-8770
Practice Address - Fax:954-969-9097
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053075207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHUMANAOther550835620
FL048914000Medicaid
FLAETNAOther4072990
FLCIGNAOther550835620
FLUNITED HEALTHCAREOther550835620
FLBLUECROSS BLUESHIELOther07358
FLCIGNAOther550835620
FL07358Medicare ID - Type Unspecified