Provider Demographics
NPI:1104913185
Name:PORTNOY, WILLIAM MARSHALL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARSHALL
Last Name:PORTNOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SW 62ND AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-662-8377
Mailing Address - Fax:305-663-8513
Practice Address - Street 1:3100 SW 62ND AVE STE 124
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-662-8377
Practice Address - Fax:305-663-8513
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175480207YX0905X
FL150098207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01634500Medicaid
NY00K731Medicare ID - Type Unspecified
NYG07056Medicare UPIN