Provider Demographics
NPI:1740320951
Name:PORTNOY, RUBEN AMOS (MD)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:AMOS
Last Name:PORTNOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W 26TH ST FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6700
Mailing Address - Country:US
Mailing Address - Phone:646-241-5796
Mailing Address - Fax:212-633-0239
Practice Address - Street 1:226 W 26TH ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6700
Practice Address - Country:US
Practice Address - Phone:646-241-5796
Practice Address - Fax:212-633-0239
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2501892084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry