Basic Information
| Provider Information | |||||||||
| NPI: | 1871635458 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EDWARD S POLASHENSKI DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 W 14TH ST | ||||||||
| Address2: | |||||||||
| City: | HAZLETON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182013266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704557677 | ||||||||
| FaxNumber: | 5704557627 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 WEST 14TH ST | ||||||||
| Address2: | |||||||||
| City: | HAZLETON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182013266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704557677 | ||||||||
| FaxNumber: | 5704557627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 06/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | POLASHENSKI | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5704557677 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO FACOI | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS 004597 L | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD 031594 E | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | MD 031594 E | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | OS 004597 L | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 182462 | 01 | PA | BLUE SHIELD | OTHER | 0010850580001 | 05 | PA | MEDICAID | 122500 | 01 | PA | BLUE SHIELD | OTHER | 0010140830002 | 05 | PA | MEDICAID |