Provider Demographics
NPI:1477611507
Name:DAVID F PORTER D.O., P.A.
Entity Type:Organization
Organization Name:DAVID F PORTER D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-288-0872
Mailing Address - Street 1:208 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1849
Mailing Address - Country:US
Mailing Address - Phone:201-288-0872
Mailing Address - Fax:201-288-8180
Practice Address - Street 1:208 BOULEVARD
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1849
Practice Address - Country:US
Practice Address - Phone:201-288-0872
Practice Address - Fax:201-288-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB306740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
132691Medicare PIN
NJE06018Medicare UPIN