Igor M Port, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

038281 Issued in NY

Practice address

24-16 Queens Plaza South
Igor Port DDS
Lic, NY 11101

Phone

(718) 205-2020

Fax

(914) 242-8599

NPI assigned

Sep 13, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mr. Igor M Port Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1639429079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24-16 QUEENS PLAZA SOUTH",
            "address_2": "IGOR PORT DDS",
            "city": "LIC",
            "state": "NY",
            "postal_code": "11101",
            "telephone_number": "718-205-2020",
            "fax_number": "914-242-8599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24-16 QUEENS PLAZA SOUTH",
            "address_2": "IGOR PORT DDS",
            "city": "LIC",
            "state": "NY",
            "postal_code": "11101",
            "telephone_number": "718-205-2020",
            "fax_number": "914-242-8599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORT",
        "first_name": "IGOR",
        "middle_name": "M",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-13",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "038281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IGOR",
            "last_name": "PORT",
            "middle_name": "M",
            "prefix": "MR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shivani Jassan, LMSW
• Rita Esther Jean, RN
• Meghan Lynch
• Hosneara Masub, MD
• Helena Morvan
• Timothy Rossen
• Amy Schnitzer
• Maureen Sullivan
• Vella Tess
• Therapeutic Resources

• General Practice Dentistry in Lic, NY
• Providers in Lic, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.