MEDICARE: DR. GARY L PORTADIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	108911	NY

General Provider Information

NPI Number	:	1275533648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY L PORTADIN MD

Provider Business Mailing Address
First Line	:	505 LAGUARDIA PL
Second Line	:	APT 7B
City	:	NEW YORK
State	:	NY
Zip	:	10012-2001
Country	:	US
Telephone Number	:	212-533-4213
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 LAGUARDIA PL
Second Line	:	APT 7B
City	:	NEW YORK
State	:	NY
Zip	:	10012-2001
Country	:	US
Telephone Number	:	212-533-4213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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