Individual
DR. JEFFREY GLENN PORTNOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
176 E 77TH ST, NEW YORK, NY 10075-1908
(212) 434-6400
Mailing address
3 UNIVERSITY PLZ STE 205, HACKENSACK, NJ 07601-6208
(201) 833-3000
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
024975
NY
103G00000X
Clinical Neuropsychologist
Primary
35SI00676600
NJ
103TC0700X
Clinical Psychologist
024975
NY
103TC0700X
Clinical Psychologist
35SI00676600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0859877
—
NJ
Enumeration date
05/12/2022
Last updated
03/07/2023
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