Provider Demographics
NPI:1649480401
Name:DR. A RICHARD POLINO DCPC
Entity type:Organization
Organization Name:DR. A RICHARD POLINO DCPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:POLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-461-6262
Mailing Address - Street 1:3001 BRIDGEBORO RD
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-9700
Mailing Address - Country:US
Mailing Address - Phone:856-461-6262
Mailing Address - Fax:856-461-7798
Practice Address - Street 1:3001 BRIDGEBORO RD
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-9700
Practice Address - Country:US
Practice Address - Phone:856-461-6262
Practice Address - Fax:856-461-7798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJMC003340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8463905Medicaid
NJ8464006Medicaid
NJ1291700Medicaid
NJ8463905Medicaid
NJU66439Medicare UPIN
NJT44638Medicare UPIN
NJT44638Medicare ID - Type Unspecified
NJU56075Medicare UPIN
NJ8464006Medicaid