Basic Information
Provider Information
NPI: 1710084348
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DELA TORRE
FirstName: POLA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 FEDERAL ST # 200
Address2:  
City: CAMDEN
State: NJ
PostalCode: 081031088
CountryCode: US
TelephoneNumber: 8563564924
FaxNumber:  
Practice Location
Address1: 3 COOPER PLZ
Address2: SUITE 513
City: CAMDEN
State: NJ
PostalCode: 081031438
CountryCode: US
TelephoneNumber: 8569633715
FaxNumber: 8566351052
Other Information
ProviderEnumerationDate: 09/17/2006
LastUpdateDate: 05/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/06/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200XMD063242LPAN Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
207RI0200XMA076514NJY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

ID Information
IDTypeStateIssuerDescription
156764901PAPENNSYLVANIA BLUE SHIELDOTHER
4021901NJUNIVERSITY HEALTH PLANOTHER
6000498501NJHORIZON-NJ HEALTHOTHER
P0025149101NJRAILROAD MEDICAREOTHER
001368405NJ MEDICAID
156764901NJAMERIHEALTH PPO PABSOTHER
652650501NJCIGNAOTHER
01000560101NJAMERICHOICEOTHER
P310619201NJOXFORD HEALTH PLANOTHER


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