Provider Demographics
NPI:1578383394
Name:POLISHCHUK, TETYANA (ANP)
Entity type:Individual
Prefix:
First Name:TETYANA
Middle Name:
Last Name:POLISHCHUK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:TETYANA
Other - Middle Name:
Other - Last Name:TUPYTSIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4844
Mailing Address - Country:US
Mailing Address - Phone:917-478-8970
Mailing Address - Fax:
Practice Address - Street 1:2 JOURNAL SQUARE PLZ STE 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4001
Practice Address - Country:US
Practice Address - Phone:551-325-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15127300363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care