Individual
MR. EDWARD J PORTLEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, NCTMB
Contact information
Practice address
347 2ND STREET PIKE, SOUTHAMPTON, PA 18966-3831
(267) 269-7388
Mailing address
10228 CLARK ST, PHILADELPHIA, PA 19116-3815
(267) 269-7388
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MSG002013
PA
Other
Enumeration date
09/27/2011
Last updated
09/27/2011
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