Provider Demographics
NPI:1992949846
Name:POLOWY, PATRICIA KEANE (NP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KEANE
Last Name:POLOWY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 MAIN
Mailing Address - Street 2:BUFFALO PEDIATRICS
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2313
Mailing Address - Country:US
Mailing Address - Phone:716-837-0995
Mailing Address - Fax:
Practice Address - Street 1:2924 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2313
Practice Address - Country:US
Practice Address - Phone:716-837-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY399931163WP0200X
NYF381398-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics