| Brian Joseph Portanova, FNP-BC | |
|
3458 Neely Rd, Mc Guire Afb, NJ 08641-5312 | |
| (609) 754-9464 | |
| (609) 754-9133 |
| Full Name | Brian Joseph Portanova |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner - Family |
| Location | 3458 Neely Rd, Mc Guire Afb, New Jersey |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336595800 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 26NJ00628000 (New Jersey) | Primary |
| 363LF0000X | Nurse Practitioner - Family | SP015756 (Pennsylvania) | Secondary |
| Entity Name | Advocare, LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770538696 PECOS PAC ID: 3678562188 Enrollment ID: O20040510001217 |
| Entity Name | Regional Cancer Care Associates LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1801850243 PECOS PAC ID: 5294710091 Enrollment ID: O20040623001494 |
| Entity Name | Garden State Psychiatric Services, LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1932766847 PECOS PAC ID: 0143550392 Enrollment ID: O20191001002322 |
| Entity Name | Regenerative Medicine of South Jersey LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1992342109 PECOS PAC ID: 5799111860 Enrollment ID: O20200210000019 |
| Entity Name | Active Health Marmora LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1629707369 PECOS PAC ID: 2961853122 Enrollment ID: O20240111004280 |
| Entity Name | Active Health Marlton LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1265161905 PECOS PAC ID: 4486097706 Enrollment ID: O20240202003806 |
| Mailing Address | Practice Location Address |
|---|---|
| Brian Joseph Portanova, FNP-BC 3458 Neely Rd, Mc Guire Afb, NJ 08641-5312 Ph: (609) 754-9464 | Brian Joseph Portanova, FNP-BC 3458 Neely Rd, Mc Guire Afb, NJ 08641-5312 Ph: (609) 754-9464 |
Adam Poller, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3458 Neely Rd, Mc Guire Afb, NJ 08641 Phone: 866-377-2778 |
Mrs. Kristine B Schwartzkopf, NP-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3458 Neely Rd, Mc Guire Afb, NJ 08641 Phone: 609-754-9155 |
Mrs. Nyasia Ivelisse Rivera, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3458 Neely Rd, Mc Guire Afb, NJ 08641 Phone: 866-377-2778 Fax: 609-754-9249 |