Provider Demographics
NPI:1306800156
Name:POLLACK, SHOSHANNAH (MD)
Entity type:Individual
Prefix:
First Name:SHOSHANNAH
Middle Name:
Last Name:POLLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 HAMBURG TPKE
Mailing Address - Street 2:STE 206
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5243
Mailing Address - Country:US
Mailing Address - Phone:973-835-1823
Mailing Address - Fax:973-831-7585
Practice Address - Street 1:1777 HAMBURG TPKE
Practice Address - Street 2:STE 206
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5243
Practice Address - Country:US
Practice Address - Phone:973-835-1823
Practice Address - Fax:973-831-7585
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ63147207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ820742Medicare PIN
NJE87421Medicare UPIN