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NPI Code Detail

MEDICARE: JUSTIN I. PORTO, D.O. P.C.

MEDICARE: JUSTIN I. PORTO, D.O. P.C.
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
1207Q00000XFamily Medicine Physician228982NY

General Provider Information

NPI Number : 1770988636
Entity Type Code : Organization
Provider Name (Legal Business Name) : JUSTIN I. PORTO, D.O. P.C.
Provider Business Mailing Address
First Line : 287 ROUTE 41
Second Line :
City : FREEHOLD
State : NY
Zip : 12431-6013
Country : US
Telephone Number : 518-929-4005
Fax Number :
Provider Business Practice Location Address
First Line : 287 ROUTE 41
Second Line :
City : FREEHOLD
State : NY
Zip : 12431-6013
Country : US
Telephone Number : 518-929-4005
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : JUSTIN I PORTO
Credential : MD
Telephone Number : 518-929-4005
Provider Enumeration Date : 11/04/2014
Last Update Date : 11/04/2014

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Directions to “JUSTIN I. PORTO, D.O. P.C. ” Practice Location

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