Provider Demographics
NPI:1578794855
Name:STANLEY L. PORTNOW, M.D., P.C.
Entity Type:Organization
Organization Name:STANLEY L. PORTNOW, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:PORTNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-288-1877
Mailing Address - Street 1:435 E. 79TH STREET
Mailing Address - Street 2:SUITE 1 B-C
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1071
Mailing Address - Country:US
Mailing Address - Phone:212-288-1877
Mailing Address - Fax:914-723-6160
Practice Address - Street 1:435 E 79TH ST
Practice Address - Street 2:SUITE 1BC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-288-1877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081538-12084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B10862Medicare UPIN
SP01980310Medicare PIN