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General NPI Number Information
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NPI Number | 1891140083
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Entity Type | Individual
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Provider Name | ELIEZER PORTNOY N.P.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | ONE GUSTAVE L LEVY PLACE
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City | NEW YORK
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State | NY
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Zip | 10029-6574
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Country | US
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Telephone | 347-931-6560
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Fax |
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Provider Business Mailing Address
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Address Line | 13-22 EASTERN DR
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City | FAIR LAWN
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State | NJ
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Zip | 07410-2303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 307819
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License Number State | NY
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