Provider Demographics
NPI:1386722601
Name:POLUZZI, JILL M
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:POLUZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 ROUTE 44 55
Mailing Address - Street 2:
Mailing Address - City:CLINTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12515-5120
Mailing Address - Country:US
Mailing Address - Phone:845-883-7545
Mailing Address - Fax:
Practice Address - Street 1:31 TED DR
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-7032
Practice Address - Country:US
Practice Address - Phone:845-744-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist