Active NPI
Robert David Polin, LCSW
- Clinical Social Worker
- Port Jefferson, NY
National Provider Identifier
1104964410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R0233061
- Practice address
- 646 Main St
Lower Level
Port Jefferson, NY 11777 - Phone
- (631) 689-8862
- Fax
- (631) 246-6492
- NPI assigned
- Feb 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R0233061 | NY | Primary |
Addresses
Primary practice location
646 Main St
Lower Level
Port Jefferson, NY 11777
Mailing address
117 Gnarled Hollow Road
East Setauket, NY 11733
Phone (631) 689-8862
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0233061 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104964410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 GNARLED HOLLOW ROAD",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "11733",
"telephone_number": "631-689-8862",
"fax_number": "631-246-6492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "646 MAIN ST",
"address_2": "LOWER LEVEL",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "11777",
"telephone_number": "631-689-8862",
"fax_number": "631-246-6492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLIN",
"first_name": "ROBERT",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R0233061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
- Alannamarie Pisani, OT
- Francis Pizzarelli, LCSW,ACSW, DCSW
- Guillermo Alejandro Plascencia, MD
- Christine Ann Podbielak, LMSW
- Kathleen Polak, PT
- Port Emergency Medical Services, P.C.
- Port Interventional Radiology PC
- Port Jefferson Allergy & Asthma P.C
- Port Jefferson Dental Group P. C.
- Port Jefferson Ekg Associates
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.