Healthcare Provider Details

I. General information

NPI: 1104128032
Provider Name (Legal Business Name): MARTIN TORRENTS, DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8502 67TH AVE
REGO PARK NY
11374-5214
US

IV. Provider business mailing address

6939 LOUBET ST
FOREST HILLS NY
11375-5845
US

V. Phone/Fax

Practice location:
  • Phone: 347-331-6533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number255974
License Number StateNY

VIII. Authorized Official

Name: MARTIN TORRENTS
Title or Position: PRESIDENT
Credential: DO
Phone: 347-331-6533