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General NPI Number Information
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NPI Number | 1013540566
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Entity Type | Individual
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Provider Name | MATTHEW DAVID POLI PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 300 W ROUTE 38 STE A
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3424
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Country | US
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Telephone | 609-267-9400
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Fax | 609-234-3921
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Provider Business Mailing Address
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Address Line | 301 LIPPINCOTT DR STE 410
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City | MARLTON
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State | NJ
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Zip | 08053-4197
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Country | US
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Telephone | 609-267-9400
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Fax | 856-234-3921
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5124-23
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00918200
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License Number State | NJ
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