Provider Demographics
NPI:1316350481
Name:PL PMR MEDICAL PC
Entity type:Organization
Organization Name:PL PMR MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORETSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-574-2177
Mailing Address - Street 1:1018 PALISADE AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6300
Mailing Address - Country:US
Mailing Address - Phone:551-574-2177
Mailing Address - Fax:
Practice Address - Street 1:1018 PALISADE AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6300
Practice Address - Country:US
Practice Address - Phone:551-574-2177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA086954002081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty