Provider Demographics
NPI:1508919143
Name:HERBERT PORTNOFF D.D.S. , P.A.
Entity Type:Organization
Organization Name:HERBERT PORTNOFF D.D.S. , P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:PORTNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-549-3773
Mailing Address - Street 1:1656 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2805
Mailing Address - Country:US
Mailing Address - Phone:732-549-3773
Mailing Address - Fax:732-549-9241
Practice Address - Street 1:1656 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2805
Practice Address - Country:US
Practice Address - Phone:732-549-3773
Practice Address - Fax:732-549-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1007129001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty