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Physician Compare National (NPI:1588673180)

HEALTHCARE PROVIDER: DAVID F PORTER D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information

NPI 1588673180
Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID 2163599333
Unique individual clinician ID assigned by PECOS
Professional Enrollment ID I20080930000594
Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name PORTER
Individual professional last name
Provider First Name DAVID
Individual professional first name
Provider Middle Name F
Individual professional middle name
Provider Gender M
The provider's gender if the provider is a person.

Medical School Information

Medical School Name MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Individual professional's medical school
Graduation Year 1975
Individual professional's medical school graduation year
Primary Specialty FAMILY MEDICINE
Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1 OSTEOPATHIC MANIPULATIVE MEDICINE
First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties OSTEOPATHIC MANIPULATIVE MEDICINE
All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information

Line 1 Street Address 208 BOULEVARD
Group Practice or individual's line 1 address
Line 2 Street Address F
Group Practice or individual's line 2 address
City HASBROUCK HEIGHTS
Group Practice or individual's city
State NJ
Group Practice or individual's state
Zip Code 076041839
Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information

Hospital Affiliation CCN 1 310008
Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1 HOLY NAME MEDICAL CENTER
Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2 310001
Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2 HACKENSACK UNIVERSITY MEDICAL CENTER
Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment Y

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