Elissa Polland, MS, CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

015148-1 Issued in NY

Practice address

966 Gerry Ave
Lido Beach, NY 11561-5217

Phone

(516) 850-1348

NPI assigned

Aug 3, 2011

Last updated

Aug 3, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elissa Jacoby Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312329600000",
    "number": "1659659910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "966 GERRY AVE",
            "city": "LIDO BEACH",
            "state": "NY",
            "postal_code": "115615217",
            "telephone_number": "516-850-1348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "966 GERRY AVE",
            "city": "LIDO BEACH",
            "state": "NY",
            "postal_code": "115615217",
            "telephone_number": "516-850-1348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLAND",
        "first_name": "ELISSA",
        "credential": "MS, CCC/SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-03",
        "last_updated": "2011-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "015148-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE EDUCATION DEPARTMENT DIVISION OF PROFESSIONAL LICENSING SERVICES",
            "identifier": "015148-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISSA",
            "last_name": "JACOBY",
            "credential": "MS, CCC/SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Lido Beach, NY
• Providers in Lido Beach, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.