Provider Demographics
NPI:1518194422
Name:GROENING, PORTIA (MD)
Entity Type:Individual
Prefix:
First Name:PORTIA
Middle Name:
Last Name:GROENING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HADDONFIELD-BERLIN ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3520
Mailing Address - Country:US
Mailing Address - Phone:856-782-2212
Mailing Address - Fax:856-782-2266
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:WESTCHESTER MEDICAL CENTER
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-8558
Practice Address - Fax:914-493-1488
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT564492080N0001X
NY2402612080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03122350Medicaid
NY03122350Medicaid