Healthcare Provider Details

I. General information

NPI: 1730392127
Provider Name (Legal Business Name): EVA TORIELLO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7815 ELIOT AVE
MIDDLE VILLAGE NY
11379-1300
US

IV. Provider business mailing address

7815 ELIOT AVE
MIDDLE VILLAGE NY
11379-1300
US

V. Phone/Fax

Practice location:
  • Phone: 718-458-8944
  • Fax: 718-458-6299
Mailing address:
  • Phone: 718-458-8944
  • Fax: 718-458-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011258-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: