Provider Demographics
NPI:1366726887
Name:POLLACK, JESSICA (DPT, CLT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:POLLACK
Suffix:
Gender:F
Credentials:DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6129 TYNDALL AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1161
Mailing Address - Country:US
Mailing Address - Phone:347-329-5330
Mailing Address - Fax:
Practice Address - Street 1:735 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5001
Practice Address - Country:US
Practice Address - Phone:914-358-2915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034327-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034327OtherLICENSE