Healthcare Provider Details

I. General information

NPI: 1356974158
Provider Name (Legal Business Name): JOQUIN TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 STATE ST
HACKENSACK NJ
07601-5500
US

IV. Provider business mailing address

PO BOX 1099
HACKENSACK NJ
07602-1099
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-0170
  • Fax: 201-488-0170
Mailing address:
  • Phone: 201-488-0170
  • Fax: 201-488-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier84-2065012
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: