Provider Demographics
NPI:1326445800
Name:BRADLEY S. PORTENOY, D.D.S,P.C.
Entity Type:Organization
Organization Name:BRADLEY S. PORTENOY, D.D.S,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATAKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-764-4386
Mailing Address - Street 1:371 MERRICK RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5359
Mailing Address - Country:US
Mailing Address - Phone:516-764-4386
Mailing Address - Fax:516-764-4389
Practice Address - Street 1:371 MERRICK RD
Practice Address - Street 2:SUITE 304
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5359
Practice Address - Country:US
Practice Address - Phone:516-764-4386
Practice Address - Fax:516-764-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty