Provider Demographics
NPI:1740436880
Name:PORTIGIANO, FRANK
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:PORTIGIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 COUNTRY CLUB DR
Mailing Address - Street 2:APT E
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3420
Mailing Address - Country:US
Mailing Address - Phone:631-736-7595
Mailing Address - Fax:
Practice Address - Street 1:29 COUNTRY CLUB DR
Practice Address - Street 2:APT E
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3420
Practice Address - Country:US
Practice Address - Phone:631-736-7595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271523-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse