Provider Demographics
NPI:1528160298
Name:PORETZKY, PAUL STEVEN (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEVEN
Last Name:PORETZKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 BEECHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1712
Mailing Address - Country:US
Mailing Address - Phone:201-585-1409
Mailing Address - Fax:201-585-7948
Practice Address - Street 1:311 BEECHWOOD PL
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1712
Practice Address - Country:US
Practice Address - Phone:201-585-1409
Practice Address - Fax:201-585-7948
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2834103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9910OtherLICENSE
NJ2834OtherLICENSE