Provider Demographics
NPI:1306221320
Name:POLIN, JESSICA T (RN)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:T
Last Name:POLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 COLUMBUS AVE
Mailing Address - Street 2:APT 5D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5901
Mailing Address - Country:US
Mailing Address - Phone:224-330-7516
Mailing Address - Fax:
Practice Address - Street 1:784 COLUMBUS AVE
Practice Address - Street 2:APT 5D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5901
Practice Address - Country:US
Practice Address - Phone:224-330-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY671369163W00000X
IL041405929163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse