Provider Demographics
NPI:1407016157
Name:POLLER, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:POLLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 EASTON AVENUE
Mailing Address - Street 2:SAINT PETER'S UNIVERSITY HOSPITAL
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901
Mailing Address - Country:US
Mailing Address - Phone:732-745-8600
Mailing Address - Fax:732-247-6145
Practice Address - Street 1:254 EASTON AVENUE
Practice Address - Street 2:SAINT PETER'S UNIVERSITY HOSPITAL
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-745-8600
Practice Address - Fax:732-247-6145
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00158300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily