Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 119422 | NY |
NPI | 1235253881 |
---|---|
Provider Name | Dr. Carlos Torres |
First Address | Brentwood, NY 11717-4304 |
Second Address | Brentwood, NY 11717-4304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00657272 | (05) | NY |
B79043 | (02) | NY |