Healthcare Provider Details

I. General information

NPI: 1154304269
Provider Name (Legal Business Name): STEVEN N. POLING D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PARK AVE
RUTHERFORD NJ
07070-2323
US

IV. Provider business mailing address

240 PARK AVE
RUTHERFORD NJ
07070-2323
US

V. Phone/Fax

Practice location:
  • Phone: 201-460-1555
  • Fax: 201-460-8090
Mailing address:
  • Phone: 201-460-1555
  • Fax: 201-460-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00164000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: