Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 175480 | NY |
NPI | 1104913185 |
---|---|
Provider Name | Dr. William Marshall Portnoy |
First Address | New York, NY 10011-5403 |
Second Address | New York, NY 10011-5403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01634500 | (05) | NY |
G07056 | (02) | NY |