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NPI Code Detail

MEDICARE: DR. JILL POLLER POLLER PSY. D.

MEDICARE: DR. JILL POLLER POLLER PSY. D.
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
1103TB0200XCognitive & Behavioral Psychologist6400NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16400OTHERNYPSYCHOLOGIST LICENSE

General Provider Information

NPI Number : 1598957789
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JILL POLLER POLLER PSY. D.
Provider Business Mailing Address
First Line : 11 RIVERSIDE DR APT 1PW
Second Line :
City : NEW YORK
State : NY
Zip : 10023-2533
Country : US
Telephone Number : 212-787-0331
Fax Number :
Provider Business Practice Location Address
First Line : 11 RIVERSIDE DR APT 1PW
Second Line :
City : NEW YORK
State : NY
Zip : 10023-2533
Country : US
Telephone Number : 212-787-0331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2007
Last Update Date : 08/13/2007

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