Healthcare Provider Details

I. General information

NPI: 1578794855
Provider Name (Legal Business Name): STANLEY L. PORTNOW, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E 79TH ST SUITE 1BC
NEW YORK NY
10075
US

IV. Provider business mailing address

435 E. 79TH STREET SUITE 1 B-C
NEW YORK CITY NY
10075-1071
US

V. Phone/Fax

Practice location:
  • Phone: 212-288-1877
  • Fax:
Mailing address:
  • Phone: 212-288-1877
  • Fax: 914-723-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number081538-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number081538-1
License Number StateNY

VIII. Authorized Official

Name: DR. STANLEY LEWIS PORTNOW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-288-1877