Active NPI
Jessica Grodio-Polasko, DVM
- Specialist
- New York, NY
National Provider Identifier
1912456005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 012460
- Practice address
- 562 Columbus Ave
New York, NY 10024-2404 - Phone
- (212) 501-8750
- NPI assigned
- Sep 29, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 012460 | NY | Primary |
Addresses
Primary practice location
562 Columbus Ave
New York, NY 10024-2404
Mailing address
562 Columbus Ave
New York, NY 10024-2404
Phone (212) 501-8750
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 |
|---|---|---|---|
| 012460 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475107200000",
"number": "1912456005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "562 COLUMBUS AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100242404",
"telephone_number": "212-501-8750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "562 COLUMBUS AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100242404",
"telephone_number": "212-501-8750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRODIO-POLASKO",
"first_name": "JESSICA",
"credential": "DVM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-29",
"last_updated": "2016-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "012460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.