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Individual

MS. HEATHER M PORTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2101 ROUTE 34 STE D, WALL TOWNSHIP, NJ 07719-9104
(732) 974-0003
Mailing address
539 LOCUST POINT RD, RUMSON, NJ 07760-2321
(732) 204-2780

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
011176
NY
363A00000X
Physician Assistant
Primary
25MP00202900
NJ

Other

Enumeration date
01/29/2007
Last updated
06/15/2010
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