Organization
PORTUM PRIVATE PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY DECKER MHA (COO)
(732) 614-0994
Entity
Organization
Contact information
Practice address
1465 ROUTE 31 S, ANNANDALE, NJ 08801-3129
(732) 614-0994
Mailing address
1465 ROUTE 31 S, ANNANDALE, NJ 08801-3129
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Enumeration date
06/24/2024
Last updated
06/24/2024
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