Healthcare Provider Details

I. General information

NPI: 1407016157
Provider Name (Legal Business Name): ADAM POLLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
MC GUIRE AFB NJ
08641-5312
US

IV. Provider business mailing address

3458 NEELY RD
MC GUIRE AFB NJ
08641-5312
US

V. Phone/Fax

Practice location:
  • Phone: 866-377-2778
  • Fax:
Mailing address:
  • Phone: 866-377-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00158300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: