MEDICARE: DR. ALMERINDO G. PORTFOLIO JR. M.D.

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	207W00000X	Ophthalmology Physician	25MA03882000	NJ
2	207W00000X	Ophthalmology Physician	140834-1	NY

General Provider Information

NPI Number	:	1669477956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALMERINDO G. PORTFOLIO JR. M.D.

Provider Business Mailing Address
First Line	:	85 HARRISTOWN RD
Second Line	:	SUITE 102
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-3329
Country	:	US
Telephone Number	:	201-445-5161
Fax Number	:	201-445-7912

Provider Business Practice Location Address
First Line	:	85 HARRISTOWN RD
Second Line	:	SUITE 102
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-3329
Country	:	US
Telephone Number	:	201-445-5161
Fax Number	:	201-445-7912

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/05/2015

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