Basic Information
| Provider Information | |||||||||
| NPI: | 1972677169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLKOW | ||||||||
| FirstName: | MELVIN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 452 OLD HOOK RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | EMERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076301381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016663900 | ||||||||
| FaxNumber: | 2012610505 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 ESSEX ST | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076013231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014981311 | ||||||||
| FaxNumber: | 2014981312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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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 | 207RP1001X | MA40598 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 0999407 | 05 | NJ | MEDICAID |