Provider Demographics
NPI:1871560268
Name:POLIS, LAURIE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:POLIS
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 1:62 CROSBY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4410
Mailing Address - Country:US
Mailing Address - Phone:212-431-1600
Mailing Address - Fax:212-431-7521
Practice Address - Street 1:62 CROSBY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4410
Practice Address - Country:US
Practice Address - Phone:212-431-1600
Practice Address - Fax:212-431-7521
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY165531207N00000X
NY165531207ND0900X, 207NI0002X, 207ND0101X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Not Answered207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Not Answered207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY96F481Medicare ID - Type UnspecifiedMEDICARE INSURANCE
NYF36261Medicare UPIN