Basic Information
| Provider Information | |||||||||
| NPI: | 1740266048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLLINA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 GEORGE KARL BLVD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142217183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162181000 | ||||||||
| FaxNumber: | 7162001857 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 GEORGE KARL BLVD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142217183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162181000 | ||||||||
| FaxNumber: | 7162001857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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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 | 207T00000X | 2015031 | NY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00025504502 | 01 | NY | UNIVERA HEALTHCARE | OTHER | 140008109 | 01 | RAILROAD MEDICARE | OTHER | 000526433005 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | 02141977 | 05 | NY | MEDICAID | 0611197 | 01 | NY | INDEPENDENT HEALTH | OTHER |