Provider Demographics
NPI:1316332315
Name:PORT, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:PORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1222
Mailing Address - Country:US
Mailing Address - Phone:718-796-4200
Mailing Address - Fax:718-874-9871
Practice Address - Street 1:5959 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1222
Practice Address - Country:US
Practice Address - Phone:718-796-4200
Practice Address - Fax:718-874-9871
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No376G00000XNursing Service Related ProvidersNursing Home Administrator