Basic Information
| Provider Information | |||||||||
| NPI: | 1639173164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PORTELLI | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 COATES DR | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109246758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456511400 | ||||||||
| FaxNumber: | 8456511512 | ||||||||
| Practice Location | |||||||||
| Address1: | 144 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109281520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454464655 | ||||||||
| FaxNumber: | 8454465455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 09/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 203472 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.