Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 263902 | NY |
NPI | 1083878102 |
---|---|
Provider Name | Dr. Joel Evan Portnoy |
First Address | Tarrytown, NY 10591-5139 |
Second Address | New Hyde Park, NY 11042-1129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 02/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
263902 | LICENSE # (01) | NY |