Provider Demographics
NPI:1194988378
Name:PORTERA, VINCENT JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:JOSEPH
Last Name:PORTERA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BROADWAY
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:917-838-3462
Mailing Address - Fax:917-451-1785
Practice Address - Street 1:1115 BROADWAY
Practice Address - Street 2:SUITE 1002
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:917-838-3462
Practice Address - Fax:917-451-1785
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor