Basic Information
| Provider Information | |||||||||
| NPI: | 1003951328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLLAK | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CPO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1211 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444608211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303378333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2235 E PERSHING ST | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444603478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303378333 | ||||||||
| FaxNumber: | 3303378373 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | LPO-0097 | OH | X | Other Service Providers | Specialist | 1744P3200X | LPO-0097 | OH | X | Other Service Providers | Specialist | Prosthetics Case Management |
No ID Information.