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1215112164
KELLY R PORTA
NEW HYDE PARK, NY
NPI
1215112164
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NY 008808)
Enumeration Date
2008-01-09
Last Update Date
2008-01-09
Business Address
KELLY R PORTA PA
27005 76TH AVE
NEW HYDE PARK, NY 11040-1433
Phone number: 718-470-4455
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Mailing Address
KELLY R PORTA PA
972 BRUSH HOLLOW RD
WESTBURY, NY 11590-1740
Phone number: 516-876-5555
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