| Doctor Name: | DR. MATTHEW BRUCE POLLACK |
| NPI Number: | 1033221338 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 0090071 |
| Business Practice Address: | 475 East Main Street Suite 214 Patchogue, NY - 11772 |
| Business Phone Number: | 6316548507 |
| Business Fax Number: | 6316548507 |
| Mailing Address: | 475 East Main Street, Suite 214 PATCHOGUE |
| State: | NY |
| Postal Code: | 11772 |
| Phone Number: | 6316548507 |
| Fax Number: | 6316548507 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 11/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 0090071 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |