Provider Demographics
NPI:1275533648
Name:PORTADIN, GARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:PORTADIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:505 LAGUARDIA PL
Mailing Address - Street 2:APT 7B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2001
Mailing Address - Country:US
Mailing Address - Phone:212-533-4213
Mailing Address - Fax:
Practice Address - Street 1:505 LAGUARDIA PL
Practice Address - Street 2:APT 7B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2001
Practice Address - Country:US
Practice Address - Phone:212-533-4213
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1089112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY679011Medicare ID - Type Unspecified