Active NPI
Jacqueline Polillo
- Contractor
- Woodbury, NJ
National Provider Identifier
1578030904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 320512873
- Practice address
- 190 N Evergreen Ave Ste 203
Woodbury, NJ 08096-1862 - Phone
- (856) 579-4247
- NPI assigned
- Oct 24, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 320512873 | NJ | Primary |
Addresses
Primary practice location
190 N Evergreen Ave Ste 203
Woodbury, NJ 08096-1862
Mailing address
190 N Evergreen Ave Ste 203
Woodbury, NJ 08096-1862
Phone (856) 579-4247
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 320512873 | NJ | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540339200000",
"number": "1578030904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 N EVERGREEN AVE STE 203",
"city": "WOODBURY",
"state": "NJ",
"postal_code": "080961862",
"telephone_number": "856-579-4247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 N EVERGREEN AVE STE 203",
"city": "WOODBURY",
"state": "NJ",
"postal_code": "080961862",
"telephone_number": "856-579-4247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLILLO",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-24",
"last_updated": "2018-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "NJ",
"license": "320512873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.