MEDICAL OFFICE OF DOCTOR ILONA K POLAK PC
NPI 1699058958
Family Medicine in Sag Harbor, NY
About Medical Office Of Doctor Ilona K Polak Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MEDICAL OFFICE OF DOCTOR ILONA K POLAK PC (NPI 1699058958) is a healthcare organization registered as a family medicine in Sag Harbor, New York and active in the NPI registry since September 2011. The organization holds a CLIA Waiver certificate valid through January 1, 2027 and lists Ilona K Polak, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Medical Office Of Doctor Ilona K Polak Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Medical Office Of Doctor Ilona K Polak PC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 33D2089527
Medical Office Of Doctor Ilona K Polak PC Dba Sag Harbor Medical Walk In · Sag Harbor, NYFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Medical Office Of Doctor Ilona K Polak PC's NPI number?
The NPI number for Medical Office Of Doctor Ilona K Polak PC is 1699058958. It was assigned to this organization in the NPPES registry on September 23, 2011.
Where is Medical Office Of Doctor Ilona K Polak PC located?
Medical Office Of Doctor Ilona K Polak PC is located at 34 Bay St # 103, Sag Harbor, NY 11963. The listed phone number is (631) 808-3337.
What is Medical Office Of Doctor Ilona K Polak PC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Medical Office Of Doctor Ilona K Polak PC enrolled in Medicare?
Yes. Medical Office Of Doctor Ilona K Polak PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Medical Office Of Doctor Ilona K Polak PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Medical Office Of Doctor Ilona K Polak PC, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Medical Office Of Doctor Ilona K Polak PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 33D2089527) is associated with this NPI, valid through January 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Medical Office Of Doctor Ilona K Polak PC was last updated on January 19, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Medical Office Of Doctor Ilona K Polak Pc · NPI 1699058958
Family Medicine organization in Sag Harbor, New York. Organization record, active in the CMS NPPES registry since September 23, 2011.
## Identity
- **NPI:** 1699058958 (Entity type: Organization)
- **Enumerated:** September 23, 2011
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Ilona Polak, PRESIDENT
## Practice location
- **Address:** 34 BAY ST # 103, Sag Harbor, NY 11963-3104
- **Phone:** (631) 808-3337 · **Fax:** (631) 808-3338
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 19, 2015
- **Other identifiers:** Medicare PIN A100062532 (NY)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1699058958) · Data from the CMS NPPES public registry.