MEDICARE: KAYLA KATHLEEN POALILLO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	26NJ15039100	NJ

General Provider Information

NPI Number	:	1174373948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA KATHLEEN POALILLO NP

Provider Business Mailing Address
First Line	:	496 ROUTE 519
Second Line	:
City	:	WANTAGE
State	:	NJ
Zip	:	07461-2900
Country	:	US
Telephone Number	:	609-851-1747
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 LAWRENCE RD
Second Line	:
City	:	NEWTON
State	:	NJ
Zip	:	07860-2821
Country	:	US
Telephone Number	:	973-948-7595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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