Provider Demographics
NPI:1669572368
Name:POROGER, EMMA (MD DO)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:POROGER
Suffix:
Gender:F
Credentials:MD DO
Other - Prefix:
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Mailing Address - Street 1:97 GIFFORDS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2011
Mailing Address - Country:US
Mailing Address - Phone:516-317-9082
Mailing Address - Fax:201-451-2031
Practice Address - Street 1:2690 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5804
Practice Address - Country:US
Practice Address - Phone:201-451-1601
Practice Address - Fax:201-451-2031
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07446800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH91886Medicare UPIN
NJ072248Medicare PIN