Provider Demographics
NPI:1407085012
Name:PORATH, MICHAL H (PT, MS)
Entity Type:Individual
Prefix:MS
First Name:MICHAL
Middle Name:H
Last Name:PORATH
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 ALLESSANDRINI AVE
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-2403
Mailing Address - Country:US
Mailing Address - Phone:201-287-0080
Mailing Address - Fax:
Practice Address - Street 1:111 DEAN DR
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2764
Practice Address - Country:US
Practice Address - Phone:201-503-7173
Practice Address - Fax:201-503-7177
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01029200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist