Provider Demographics
NPI:1194001784
Name:PORTER, HERBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:M
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0435
Mailing Address - Country:US
Mailing Address - Phone:212-861-3472
Mailing Address - Fax:121-286-1347
Practice Address - Street 1:156 E 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0435
Practice Address - Country:US
Practice Address - Phone:212-861-3472
Practice Address - Fax:121-286-1347
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY76042208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics