Provider Demographics
NPI:1053374835
Name:POLLACK, BARRY J (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:J
Last Name:POLLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S STE 105
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1926
Mailing Address - Country:US
Mailing Address - Phone:816-350-4215
Mailing Address - Fax:816-350-4220
Practice Address - Street 1:19550 E 39TH ST S STE 105
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1926
Practice Address - Country:US
Practice Address - Phone:816-350-4215
Practice Address - Fax:816-350-4220
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY225485207T00000X
MO2017000597207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1053374835Medicaid
NYP00475580Medicare PIN
NYE61097Medicare UPIN