MEDICARE: JULIE POLANCO

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386419844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE POLANCO

Provider Business Mailing Address
First Line	:	2304 BRUNSWICK AVE
Second Line	:
City	:	LAWRENCE TOWNSHIP
State	:	NJ
Zip	:	08648-4411
Country	:	US
Telephone Number	:	347-415-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 BRUNSWICK AVE
Second Line	:
City	:	LAWRENCE
State	:	NJ
Zip	:	08648-4411
Country	:	US
Telephone Number	:	844-222-2645
Fax Number	:

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

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	12/12/2024

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Directions to “ JULIE POLANCO ” Practice Location

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