Provider Demographics
NPI:1386979490
Name:POLLICHINO, PAUL (CO,P)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:POLLICHINO
Suffix:
Gender:M
Credentials:CO,P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 SUNNYSIDE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1591
Mailing Address - Country:US
Mailing Address - Phone:516-576-6114
Mailing Address - Fax:516-576-6115
Practice Address - Street 1:88 SUNNYSIDE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1591
Practice Address - Country:US
Practice Address - Phone:516-576-6114
Practice Address - Fax:516-576-6115
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier