Provider Demographics
NPI:1750577839
Name:JOSEPH B. PORDER, M.D., PC
Entity type:Organization
Organization Name:JOSEPH B. PORDER, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PORDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-860-5500
Mailing Address - Street 1:1160 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6928
Mailing Address - Country:US
Mailing Address - Phone:212-860-5500
Mailing Address - Fax:212-860-1690
Practice Address - Street 1:1160 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6928
Practice Address - Country:US
Practice Address - Phone:212-860-5500
Practice Address - Fax:212-860-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156451207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEV961Medicare PIN