Healthcare Provider Details

I. General information

NPI: 1306530035
Provider Name (Legal Business Name): ROMMEL SISON TORIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date: 01/08/2024
Reactivation Date: 01/12/2024

III. Provider practice location address

355 BARD AVENUE DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
STATEN ISLAND NY
10310
US

IV. Provider business mailing address

355 BARD AVENUE
STATEN ISLAND NY
10310
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-2419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1.084175
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: