Provider Demographics
NPI:1104894054
Name:PORTELA, MARGARET (DPM)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:
Last Name:PORTELA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BRIGHTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2028
Mailing Address - Country:US
Mailing Address - Phone:201-998-8008
Mailing Address - Fax:201-863-0727
Practice Address - Street 1:4808 BERGENLINE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5172
Practice Address - Country:US
Practice Address - Phone:201-863-0036
Practice Address - Fax:201-863-0727
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD00276600213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3354601Medicaid
NJ0039047Medicaid
NJ0039047Medicaid
NJ3354601Medicaid