Healthcare Provider Details

I. General information

NPI: 1003207978
Provider Name (Legal Business Name): EMMANUELLE CORDERO TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE DEPT OF NEPHROLOGY ALBANY MEDICAL CENTER
ALBANY NY
12208
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE, DEPT OF NEPHROLOGY ALBANY MEDICAL CENTER
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5377
  • Fax:
Mailing address:
  • Phone: 518-262-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31007R
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number63855
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: