Healthcare Provider Details

I. General information

NPI: 1124192505
Provider Name (Legal Business Name): JANE FRANCES POLLEY RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 OAK ST LONGFELLOW SPORTS CLUB
NATICK MA
01760-1306
US

IV. Provider business mailing address

210 NAHANTON ST BOX 106
NEWTON CENTER MA
02459-2954
US

V. Phone/Fax

Practice location:
  • Phone: 508-653-4633
  • Fax: 508-650-4986
Mailing address:
  • Phone: 508-641-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN1011
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: