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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