Provider Demographics
NPI:1316930423
Name:POLONY, ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:POLONY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DEARBORN RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-8836
Mailing Address - Country:US
Mailing Address - Phone:978-998-6821
Mailing Address - Fax:
Practice Address - Street 1:10 DEARBORN RD
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-8836
Practice Address - Country:US
Practice Address - Phone:978-998-6821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1696552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01089298Medicaid
NYP00337162OtherRR MEDICARE PIN
PAGU039853OtherPA MEDICARE GROUP
PAGU058887OtherPA MEDICARE GROUP
PA1017988430001Medicaid
NYCC8362OtherRR MEDICARE GROUP
PAE15498Medicare UPIN
PA1017988430001Medicaid
PA118582N87Medicare PIN
NYRB1143Medicare PIN