Provider Demographics
NPI:1942507900
Name:PORTELLI, JUDY (NP-C)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:PORTELLI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 ROCKVILLE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1621
Mailing Address - Country:US
Mailing Address - Phone:516-764-9501
Mailing Address - Fax:
Practice Address - Street 1:2380 ROCKVILLE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1621
Practice Address - Country:US
Practice Address - Phone:516-764-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335989-1363LF0000X
NY436331163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse