Provider Demographics
NPI:1649789298
Name:PORTOGHESE, PATRICIA
Entity type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:
Last Name:PORTOGHESE
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 1:103 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3429
Mailing Address - Country:US
Mailing Address - Phone:516-448-0267
Mailing Address - Fax:
Practice Address - Street 1:103 ASPEN ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3429
Practice Address - Country:US
Practice Address - Phone:516-448-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty