Provider Demographics
NPI:1760636682
Name:PORCO, JANINE JOAN (RN)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:JOAN
Last Name:PORCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 BEAVER LN
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6019
Mailing Address - Country:US
Mailing Address - Phone:631-981-8226
Mailing Address - Fax:
Practice Address - Street 1:560 BEAVER LN
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6019
Practice Address - Country:US
Practice Address - Phone:631-981-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY566276163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY566276Medicaid