Healthcare Provider Details

I. General information

NPI: 1477557999
Provider Name (Legal Business Name): IVETTE BERNADETTE TORRES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 GIDNEY AVE
NEWBURGH NY
12550-3117
US

IV. Provider business mailing address

460 GIDNEY AVE
NEWBURGH NY
12550-3117
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-2810
  • Fax: 845-565-2879
Mailing address:
  • Phone: 845-565-2810
  • Fax: 845-565-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number139409
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: