Healthcare Provider Details

I. General information

NPI: 1508520917
Provider Name (Legal Business Name): JAMIE DOROTHY PORTEUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 02/05/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 E 57TH STREET
NEW YORK NY
10022-2500
US

IV. Provider business mailing address

505 PARK AVE
NEW YORK NY
10022-1106
US

V. Phone/Fax

Practice location:
  • Phone: 212-600-2000
  • Fax: 212-540-0857
Mailing address:
  • Phone: 212-200-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1108472
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: