Provider Demographics
NPI:1487273926
Name:SUERO POLANCO, YANERIS ALTAGRACIA (MD)
Entity type:Individual
Prefix:
First Name:YANERIS
Middle Name:ALTAGRACIA
Last Name:SUERO POLANCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 TINTON AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5464
Mailing Address - Country:US
Mailing Address - Phone:347-358-5542
Mailing Address - Fax:
Practice Address - Street 1:199 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3501
Practice Address - Country:US
Practice Address - Phone:203-874-2543
Practice Address - Fax:203-874-2544
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY102156-01207R00000X
CT79118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine