Provider Information for 1134613342
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NICHOLAS F POLK Professional Clinica
Sex: Male
NPI: 1134613342
Last Updated: 2022-01-10
Certification Date: 2022-01-10
Certification Date: 2022-01-10
Details
Name | Value | ||||||||||||||||
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NPI | 1134613342 | ||||||||||||||||
Enumeration Date | 2018-06-20 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | 3458 NEELY RD TRENTON, NJ 08641-5312 United States Phone: 609-754-9324 | Fax: | ||||||||||||||||
Primary Practice Address | 3458 NEELY RD TRENTON, NJ 08641-5312 United States Phone: 609-754-9324 | Fax: | ||||||||||||||||
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