Healthcare Provider Details

I. General information

NPI: 1972687085
Provider Name (Legal Business Name): ANDREA S. PORTO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA S. PALERMO D.O.

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 ATLANTIC AVE
ATLANTIC CITY NJ
08401
US

IV. Provider business mailing address

PO BOX 1309
MARLTON NJ
08053-6309
US

V. Phone/Fax

Practice location:
  • Phone: 609-348-0066
  • Fax: 609-348-1157
Mailing address:
  • Phone: 609-567-0200
  • Fax: 609-704-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMB06634300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB06634300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: