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General NPI Number Information
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NPI Number | 1689424012
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Entity Type | Individual
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Provider Name | KEVIN LEE POLLARD JR.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 1116 WAVERLY AVE
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City | HOLTSVILLE
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State | NY
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Zip | 11742-1114
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Country | US
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Telephone | 631-408-2213
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 77
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City | FARMINGVILLE
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State | NY
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Zip | 11738-0077
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Country | US
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Telephone | 631-408-2213
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Fax |
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | 555559628
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License Number State | NY
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