Active NPI
Scott Lee Poltrock, PH.D.
- Clinical Psychologist
- Cherry Hill, NJ
National Provider Identifier
1861626442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 35SI00466500
- Practice address
- 1812 Haddonfield Berlin Rd
Cherry Hill, NJ 08003-3736 - Phone
- (732) 535-3481
- Fax
- (732) 587-0713
- NPI assigned
- May 11, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 35SI00466500 | NJ | Primary |
Addresses
Primary practice location
1812 Haddonfield Berlin Rd
Cherry Hill, NJ 08003-3736
Mailing address
1812 Haddonfield Berlin Rd
Cherry Hill, NJ 08003-3736
Phone (732) 535-3481
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427241600000",
"number": "1861626442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1812 HADDONFIELD BERLIN RD",
"city": "CHERRY HILL",
"state": "NJ",
"postal_code": "080033736",
"telephone_number": "732-535-3481",
"fax_number": "732-587-0713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1812 HADDONFIELD BERLIN RD",
"city": "CHERRY HILL",
"state": "NJ",
"postal_code": "080033736",
"telephone_number": "732-535-3481",
"fax_number": "732-587-0713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLTROCK",
"first_name": "SCOTT",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-11",
"last_updated": "2015-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "35SI00466500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cherry Hill, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.