Provider Demographics
NPI:1609980390
Name:PORTER, LAUREL (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RIVERSIDE DR
Mailing Address - Street 2:APT 4E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1860
Mailing Address - Country:US
Mailing Address - Phone:212-222-9930
Mailing Address - Fax:
Practice Address - Street 1:400 RIVERSIDE DR
Practice Address - Street 2:APT 4E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1860
Practice Address - Country:US
Practice Address - Phone:212-222-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157301207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02906398Medicaid
NY64657ZT5H1Medicare PIN
NY02906398Medicaid
NY646571Medicare PIN
NY0650VAMedicare PIN
NY64657YRXP1Medicare PIN
NY64657ZXWW1Medicare PIN