MEDICARE: PORTL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1033049267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTL HEALTH LLC

Provider Business Mailing Address
First Line	:	205 CLUB DR
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-2017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 CLUB DR
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-2017
Country	:	US
Telephone Number	:	201-937-9321
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELLIOT FUCHS
Credential	:
Telephone Number	:	281-732-4106

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/27/2026

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Directions to “PORTL HEALTH LLC ” Practice Location

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