Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 228982 | NY |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS18111 | FL |
NPI | 1508868910 |
---|---|
Provider Name | Justin I Porto |
First Address | Ocala, FL 34474-8489 |
Second Address | Albany, NY 12208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02544416 | (05) | NY |