Healthcare Provider Details

I. General information

NPI: 1588673180
Provider Name (Legal Business Name): DAVID F PORTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 BOULEVARD
HASBROUCK HEIGHTS NJ
07604
US

IV. Provider business mailing address

208 BOULEVARD
HASBROUCK HEIGHTS NJ
07604
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 NumberMB036740
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: