MEDICARE: DR. JOEL EVAN PORTNOY M.D.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	263902	NY
2	207Y00000X	Otolaryngology Physician	263902	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	263902	OTHER	NY	LICENSE #

General Provider Information

NPI Number	:	1083878102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL EVAN PORTNOY M.D.

Provider Business Mailing Address
First Line	:	660 WHITE PLAINS RD FL 4
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-5139
Country	:	US
Telephone Number	:	914-984-2546
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 OHIO DR STE 202
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1129
Country	:	US
Telephone Number	:	516-775-2800
Fax Number	:	516-775-0859

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/25/2025

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Directions to “ DR. JOEL EVAN PORTNOY M.D.” Practice Location

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