Healthcare Provider Details

I. General information

NPI: 1033049267
Provider Name (Legal Business Name): PORTL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CLUB DR
WOODMERE NY
11598-2017
US

IV. Provider business mailing address

205 CLUB DR
WOODMERE NY
11598-2017
US

V. Phone/Fax

Practice location:
  • Phone: 201-937-9321
  • Fax:
Mailing address:
  • Phone: 201-937-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ELLIOT FUCHS
Title or Position: OWNER
Credential:
Phone: 201-937-9321