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Contact Information

RUSSELL PORTER, MD
2000 NORTH VILLIAGE AVE
STE 307
ROCKVILLE CENTRE, NY11570-1001
 Phone: 516-766-5051
 Fax: 516-766-2476
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Geriatric Medicine

207RG0300X 11 Physician/Internal Medicine
 

Sports Medicine

207XX0005X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for RUSSELL PORTER · (Male)

NPI # 1275511560
Status Active
Credentials MD
Entity Individual
Enumeration date 01/06/2006
Last updated 03/07/2023 - About 3 years ago
Sole proprietor 1 Yes
Identifiers
  • NY License # 136530
  • NY Medicaid 00598458
  • Other 36A761 BCBS
  • Other AB45677 MDNY
  • Other AP970 OXFORD
  • Other OC7613 PHS
  • Other 927080 PHS FOR REFERRALS
  • Other 2590505 UNEMPLOYMENT ER
  • Other 559637 US HEALTHCARE
  • NY Other CFP1365303 WC
Hospital affiliation(s)
  • MERCY MEDICAL CENTER - (Acute Care)
    1000 NORTH VILLAGE AVENUE
    ROCKVILLE CENTRE, NY 11570
  • SOUTH NASSAU COMMUNITIES HOSPITAL - (Acute Care)
    ONE HEALTHY WAY
    OCEANSIDE, NY 11572
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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