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General NPI Number Information
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NPI Number | 1093916462
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Entity Type | Organization
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Legal Business Name | ANDREW J PORGES, MD PC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 1044 NORTHERN BLVD SUITE 104
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City | ROSLYN
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State | NY
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Zip | 11576-1514
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Country | US
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Telephone | 516-484-6880
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Fax | 516-484-6882
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Provider Business Mailing Address
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Address Line | 1044 NORTHERN BLVD SUITE 104
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City | ROSLYN
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State | NY
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Zip | 11576-1514
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Country | US
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Telephone | 516-484-6880
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Fax | 516-484-6882
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ANDREW J PORGES
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Credential | MD
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Telephone | 516-484-6880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 171799
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License Number State | NY
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