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Organization
PORTUM PRIVATE PRACTICE LLC
Active
Organization
PORTUM PRIVATE PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY ALLEN DECKER MHA (CHIEF OPERATING OFFICER)
(732) 614-0994
Entity
Organization
Contact information
Practice address
1465 ROUTE 31 S STE 11011102, ANNANDALE, NJ 08801-3129
(732) 614-0994
Mailing address
1465 ROUTE 31 S STE 1101102, ANNANDALE, NJ 08801-3129
(732) 614-0994
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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