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Contact Information

MARK P ORTIZ, PA-C
800 HOWARD AVE LOWR LEVEL
NEW HAVEN, CT06519-1369
 Phone: 203-785-4085
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neurology

2084N0400X 13 Physician/Neurology
Indicates primary specialty

NPI Profile & details for MARK P ORTIZ · (Male)

NPI # 1740796465
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 12/18/2017
Last updated 04/19/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • CT License # 6525
  • NY License # 021715
Hospital affiliation(s)
  • JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON - (Acute Care)
    75 NORTH COUNTRY ROAD
    PORT JEFFERSON, NY 11777
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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