Healthcare Provider Details

I. General information

NPI: 1548100555
Provider Name (Legal Business Name): JUAN CARLOS TORRES FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 E 174TH ST
BRONX NY
10472-1801
US

IV. Provider business mailing address

5702 BROADWAY APT 2
WEST NEW YORK NJ
07093-2718
US

V. Phone/Fax

Practice location:
  • Phone: 718-994-2273
  • Fax: 718-443-3700
Mailing address:
  • Phone: 201-951-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number359385
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: