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General NPI Number Information
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NPI Number | 1952448953
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Entity Type | Individual
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Provider Name | DIANNE R PORTER MSED
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 11 WHITE BIRCH DR
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City | CENTEREACH
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State | NY
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Zip | 11720-3827
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Country | US
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Telephone | 516-429-0788
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Fax |
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Provider Business Mailing Address
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Address Line | 31 MARK DR
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City | HOLBROOK
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State | NY
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Zip | 11741-5810
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Country | US
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Telephone | 631-567-5412
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State | NY
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