Active NPI
Jill Poller Poller, PSY. D.
- Cognitive & Behavioral Psychologist
- New York, NY
National Provider Identifier
1598957789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- 6400
- Practice address
- 11 Riverside Dr Apt 1PW
New York, NY 10023-2533 - Phone
- (212) 787-0331
- NPI assigned
- Aug 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 6400 | NY | Primary |
Addresses
Primary practice location
11 Riverside Dr Apt 1PW
New York, NY 10023-2533
Mailing address
11 Riverside Dr Apt 1PW
New York, NY 10023-2533
Phone (212) 787-0331
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6400 | Other | NY | PSYCHOLOGIST LICENSE |
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 |
|---|---|---|---|
| 6400 | NY | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186963200000",
"number": "1598957789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 RIVERSIDE DR APT 1PW",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100232533",
"telephone_number": "212-787-0331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 RIVERSIDE DR APT 1PW",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100232533",
"telephone_number": "212-787-0331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLER",
"first_name": "JILL",
"middle_name": "POLLER",
"name_prefix": "Dr.",
"credential": "PSY. D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-13",
"last_updated": "2007-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NY",
"license": "6400",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST LICENSE",
"identifier": "6400",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.