MEDICARE: DREW POLHEMUS

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	2255A2300X	Athletic Trainer
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1245794569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DREW POLHEMUS

Provider Business Mailing Address
First Line	:	30 CAMBRIDGE RD
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-3167
Country	:	US
Telephone Number	:	732-890-9694
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 ROSEBERRY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3721
Country	:	US
Telephone Number	:	732-890-9694
Fax Number	:

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

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	06/26/2025

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Directions to “ DREW POLHEMUS ” Practice Location

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