Provider Demographics
NPI:1447768064
Name:POLESKY, CHRISTINA M (CNM)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:POLESKY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 WESTWAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1458
Mailing Address - Country:US
Mailing Address - Phone:203-638-4421
Mailing Address - Fax:
Practice Address - Street 1:761 MAIN AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1080
Practice Address - Country:US
Practice Address - Phone:203-750-7400
Practice Address - Fax:203-846-9579
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000612176B00000X
CT16.000275176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife