Provider Demographics
NPI:1245367515
Name:PORCARO, JANE THERESA
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:THERESA
Last Name:PORCARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 BROADWAY AVE
Mailing Address - Street 2:APT. 85B
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4953
Mailing Address - Country:US
Mailing Address - Phone:631-836-1906
Mailing Address - Fax:631-750-3179
Practice Address - Street 1:865 BROADWAY AVE
Practice Address - Street 2:APT. 85B
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4953
Practice Address - Country:US
Practice Address - Phone:631-836-1906
Practice Address - Fax:631-750-3179
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004056-1224Z00000X
NY014578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant