Provider Demographics
NPI:1215132675
Name:POLIKOFF, MARGO LANE (RN)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:LANE
Last Name:POLIKOFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DEERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1904
Mailing Address - Country:US
Mailing Address - Phone:607-257-7794
Mailing Address - Fax:
Practice Address - Street 1:508 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2218
Practice Address - Country:US
Practice Address - Phone:607-674-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY425491-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse