Portum Private Practice LLC
Clinic/Center, Adolescent and Children Mental Health in Annandale, New Jersey
1255103388- Practice location
- 1465 Route 31 S Ste 11011102, Annandale, NJ 08801-3129
- Phone
- 732-614-0994
- Fax
- —
- Last updated
- October 23, 2023
Portum Private Practice LLC is a healthcare organization based in Annandale, NJ. Portum Private Practice LLC practices in Annandale, NJ. The NPI Number for Portum Private Practice LLC is 1255103388. The current practice location address for Portum Private Practice LLC is 1465 Route 31 S Ste 11011102, Annandale, NJ 08801-3129 and can be reached out via phone at 732-614-0994.
Provider Profile Details
- NPI Number
- 1255103388
- Provider Name
- Portum Private Practice LLC
- Provider Entity Type
- Organization
- Address
- 1465 Route 31 S Ste 11011102, Annandale, NJ 08801-3129
- Phone Number
- 732-614-0994
- Primary Taxonomy
- Clinic/Center, Adolescent and Children Mental Health · 261QM0855X
- Organization Subpart
- No
- Authorized Official
- Mr. Jeffrey Allen Decker, MHA · Chief Operating Officer · 732-614-0994
- Provider Enumeration Date
- October 23, 2023
- Last Update Date
- October 23, 2023
- Certification Date
- October 23, 2023
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 1465 Route 31 S Ste 11011102
Annandale, NJ 08801-3129 - City
- Annandale
- State
- New Jersey
- Zip
- 08801-3129
- Phone Number
- 732-614-0994
Provider Business Mailing Address Details
- Address
- 1465 Route 31 S Ste 1101102
Annandale, NJ 08801-3129 - City
- Annandale
- State
- NJ
- Zip
- 08801-3129
- Phone Number
- 732-614-0994
License Information
- Taxonomy
- Clinic/Center, Adolescent and Children Mental Health · 261QM0855X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Clinic/Center, Adolescent and Children Mental Health providers near Annandale, NJ
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- Mrs. Tiffany L Walck, APN-CPsychiatry & Neurology, Neurology · NPI 1952043200
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Frequently Asked Questions
What is the NPI number of Portum Private Practice LLC?
The NPI number of Portum Private Practice LLC is 1255103388. It was assigned on October 23, 2023 and is currently active in the NPPES registry.
What is the specialty of Portum Private Practice LLC?
Portum Private Practice LLC is registered under the primary taxonomy Clinic/Center, Adolescent and Children Mental Health (code 261QM0855X).
Where does Portum Private Practice LLC practice?
The practice location is 1465 Route 31 S Ste 11011102, Annandale, NJ 08801-3129. The office can be reached at 732-614-0994 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1255103388 directly on the NPPES registry website.