MEDICARE: NEIL HAROLD POULSEN

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	2086S0129X	Vascular Surgery Physician	25MA11141900	NJ

General Provider Information

NPI Number	:	1841610821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL HAROLD POULSEN

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6457
Country	:	US
Telephone Number	:	844-362-1735
Fax Number	:	973-290-7495

Provider Business Practice Location Address
First Line	:	333 MOUNT HOPE AVE STE 260
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-1657
Country	:	US
Telephone Number	:	973-895-6605
Fax Number	:	973-895-5338

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

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	10/07/2021

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Directions to “ NEIL HAROLD POULSEN ” Practice Location

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