1. Home
  2. Directory
  3. New Jersey
  4. Annandale
  5. Clinic Center
  6. NPI Profile

PORTUM PRIVATE PRACTICE LLC
NPI 1255103388
Clinic/Center - Adolescent and Children Mental Health in Annandale, NJ

Active since October 23, 2023
1465 ROUTE 31 S STE 11011102, ANNANDALE, NJ 08801(732) 614-0994 Get Directions Write a Review

NPPES record last updated: October 23, 2023. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Portum Private Practice Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PORTUM PRIVATE PRACTICE LLC (NPI 1255103388) is a healthcare organization registered as an adolescent and children mental health in Annandale, New Jersey and active in the NPI registry since October 2023. The organization lists Jeffrey Allen Decker, Chief Operating Officer, as its authorized official.

NPPES Registry Identity

NPI1255103388
Entity TypeOrganization
Primary Taxonomy261QM0855X
Legal Business NamePORTUM PRIVATE PRACTICE LLC
Location Address1465 ROUTE 31 S STE 11011102Annandale, NJ 08801-3129
Mailing Address1465 Route 31 S Ste 1101102Annandale, NJ 08801-3129 · (732) 614-0994
Phone(732) 614-0994
Organization SubpartNo
Authorized OfficialJeffrey Allen DeckerChief Operating Officer · (732) 614-0994
Enumeration DateOctober 23, 2023
NPPES CertifiedOctober 23, 2023
✔ NPI 1255103388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Adolescent and Children Mental HealthAmbulatory Health Care Facilities
Taxonomy Code261QM0855X
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
1465 ROUTE 31 S STE 11011102, Annandale, NJ 08801
Open in Google Maps ↗

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Portum Private Practice LLC's NPI number?

The NPI number for Portum Private Practice LLC is 1255103388. It was assigned to this organization in the NPPES registry on October 23, 2023.

Where is Portum Private Practice LLC located?

Portum Private Practice LLC is located at 1465 Route 31 S Ste 11011102, Annandale, NJ 08801. The listed phone number is (732) 614-0994.

What is Portum Private Practice LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adolescent and Children Mental Health, with taxonomy code 261QM0855X.

When was this NPI record last updated?

The NPPES record for Portum Private Practice LLC was last updated on October 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.