Individual
MRS. POLLY JANE YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
99 EAST STATE STREET, GLOVERSVILLE, NY 12078
(518) 752-5275
(518) 752-5277
Mailing address
PO BOX 1250, 99 EAST STATE STREET, GLOVERSVILLE, NY 12078
(518) 752-5275
(518) 752-5277
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
303481
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F303481
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000403459002
BSH NE NY
NY
05
—
02357431
—
NY
01
—
696035
MVP HEALTHPLAN
NY
Enumeration date
06/30/2006
Last updated
07/07/2021
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