Healthcare Provider Details

I. General information

NPI: 1164410080
Provider Name (Legal Business Name): MARIO E TORRENTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 CENTRAL AVE LOWER LEVEL
CEDARHURST NY
11516-2320
US

IV. Provider business mailing address

657 CENTRAL AVE LOWER LEVEL
CEDARHURST NY
11516-2320
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-5760
  • Fax: 516-295-4720
Mailing address:
  • Phone: 516-295-5760
  • Fax: 516-295-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number157774-1
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier00846020
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: