Provider Demographics
NPI:1316906639
Name:POLENBERG, SAUL (OD)
Entity type:Individual
Prefix:DR
First Name:SAUL
Middle Name:
Last Name:POLENBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FULTON CT
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2802
Mailing Address - Country:US
Mailing Address - Phone:845-471-3650
Mailing Address - Fax:845-471-3650
Practice Address - Street 1:7 FULTON CT
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2802
Practice Address - Country:US
Practice Address - Phone:845-471-3650
Practice Address - Fax:845-471-3650
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003022-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT49185Medicare UPIN
NYC93911Medicare ID - Type Unspecified