Provider Demographics
NPI:1598957789
Name:POLLER, JILL POLLER (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:POLLER
Last Name:POLLER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RIVERSIDE DR APT 1PW
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2533
Mailing Address - Country:US
Mailing Address - Phone:212-787-0331
Mailing Address - Fax:
Practice Address - Street 1:11 RIVERSIDE DR APT 1PW
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2533
Practice Address - Country:US
Practice Address - Phone:212-787-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6400103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6400OtherPSYCHOLOGIST LICENSE