Provider Demographics
NPI:1275726697
Name:PORAT, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:PORAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 OLD STEVENS LN
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3417
Mailing Address - Country:US
Mailing Address - Phone:516-242-7624
Mailing Address - Fax:
Practice Address - Street 1:406 LIPPINCOTT DR STE E
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4168
Practice Address - Country:US
Practice Address - Phone:856-983-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432112207RG0100X
NJ25MA10230400207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology