Provider Demographics
NPI:1508520917
Name:PORTEUS, JAMIE DOROTHY
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:DOROTHY
Last Name:PORTEUS
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 1:505 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1106
Mailing Address - Country:US
Mailing Address - Phone:212-200-6000
Mailing Address - Fax:
Practice Address - Street 1:36 E 57TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2500
Practice Address - Country:US
Practice Address - Phone:212-600-2000
Practice Address - Fax:212-540-0857
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1108472363LF0000X
NY348175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily