Healthcare Provider Details

I. General information

NPI: 1477611507
Provider Name (Legal Business Name): DAVID F PORTER D.O., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 BOULEVARD
HASBROUCK HEIGHTS NJ
07604-1849
US

IV. Provider business mailing address

208 BOULEVARD
HASBROUCK HEIGHTS NJ
07604-1849
US

V. Phone/Fax

Practice location:
  • Phone: 201-288-0872
  • Fax: 201-288-8180
Mailing address:
  • Phone: 201-288-0872
  • Fax: 201-288-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB306740
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID F PORTER
Title or Position: DR.
Credential: D.O.
Phone: 201-288-0872