Doctor Poretskaya Medical Practice, P.a.

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

25MA08695400 Issued in NJ

Legal business name

DOCTOR PORETSKAYA MEDICAL PRACTICE, P.A.

Practice address

645 Elizabeth Ave
Elizabeth, NJ 07206-1131

Phone

(908) 662-2222

Fax

(908) 450-6150

NPI assigned

Nov 5, 2014

Last updated

Nov 5, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lyudmila Poretskaya, M.D.

Title

Owner

Phone

(551) 574-2177

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1415145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415145600000",
    "number": "1912303819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 PALISADE AVE",
            "address_2": "APT 18",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070246300",
            "telephone_number": "908-662-2222",
            "fax_number": "908-450-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 ELIZABETH AVE",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072061131",
            "telephone_number": "908-662-2222",
            "fax_number": "908-450-6150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTOR PORETSKAYA MEDICAL PRACTICE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-05",
        "last_updated": "2014-11-05",
        "status": "A",
        "authorized_official_last_name": "PORETSKAYA",
        "authorized_official_first_name": "LYUDMILA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "551-574-2177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "NJ",
            "license": "25MA08695400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Legal Medicine in Elizabeth, NJ
• Providers in Elizabeth, NJ by specialty
• Legal Medicine in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; 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.