Provider Demographics
NPI:1447350707
Name:PORTNOW, STANLEY LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LEWIS
Last Name:PORTNOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:435 E 79TH ST
Mailing Address - Street 2:#1 BC
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1071
Mailing Address - Country:US
Mailing Address - Phone:212-288-1877
Mailing Address - Fax:914-723-6160
Practice Address - Street 1:435 E 79TH ST
Practice Address - Street 2:#1 BC
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10021-1071
Practice Address - Country:US
Practice Address - Phone:212-288-1877
Practice Address - Fax:914-723-6160
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08153802084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B10862Medicare UPIN
SP01980310Medicare ID - Type Unspecified