Provider Demographics
NPI:1679686893
Name:POLESIN, ALENA
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:POLESIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1486
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-1486
Mailing Address - Country:US
Mailing Address - Phone:973-538-2334
Mailing Address - Fax:973-829-9174
Practice Address - Street 1:160 E HANOVER AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-3150
Practice Address - Country:US
Practice Address - Phone:973-538-2334
Practice Address - Fax:973-829-9174
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07985100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223014220OtherTAX ID#
NJ223014220OtherTAX ID#
NJ103535AD6Medicare PIN