| Portum Private Practice Llc | |
|
1465 Route 31 S Annandale NJ 08801-3129 | |
| (732) 614-0994 | |
| Not Available |
| Full Name | Portum Private Practice Llc |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 1465 Route 31 S, Annandale, New Jersey |
| Authorized Official Name and Position | Jeffrey Decker (COO) |
| Authorized Official Contact | 7326140994 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portum Private Practice Llc 1465 Route 31 S Annandale NJ 08801-3129 Ph: () - | Portum Private Practice Llc 1465 Route 31 S Annandale NJ 08801-3129 Ph: (732) 614-0994 |
| NPI Number | 1528802568 |
|---|---|
| Provider Enumeration Date | 06/24/2024 |
| Last Update Date | 06/24/2024 |
| Certification Date | 06/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528802568 | NPI | - | NPPES |
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