Basic Information
Provider Information | |||||||||
NPI: | 1962674937 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PORTNOY-SAITTA | ||||||||
FirstName: | PAMELA | ||||||||
MiddleName: | DAWN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 HEALTHY WAY | ||||||||
Address2: | EMERGENCY DEPARTMENT, SOUTH NASSAU COMMUNITIES HOSPITAL | ||||||||
City: | OCEANSIDE | ||||||||
State: | NY | ||||||||
PostalCode: | 115721551 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5166323900 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1 HEALTHY WAY | ||||||||
Address2: | EMERGENCY DEPARTMENT, SOUTH NASSAU COMMUNITIES HOSPITAL | ||||||||
City: | OCEANSIDE | ||||||||
State: | NY | ||||||||
PostalCode: | 115721551 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5166323900 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/30/2008 | ||||||||
LastUpdateDate: | 07/30/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 248006 | NY | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.