Healthcare Provider Details

I. General information

NPI: 1881053239
Provider Name (Legal Business Name): THE AUTISM TELEMEDICINE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2016
Last Update Date: 02/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BLACK WALNUT LN
PLYMOUTH MEETING PA
19462-1948
US

IV. Provider business mailing address

119 BLACK WALNUT LN
PLYMOUTH MEETING PA
19462-1948
US

V. Phone/Fax

Practice location:
  • Phone: 610-567-3857
  • Fax:
Mailing address:
  • Phone: 610-567-3857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD059220L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberMD059220L
License Number StatePA

VIII. Authorized Official

Name: DR. BRIAN R TORCATO
Title or Position: CEO
Credential: M.D.
Phone: 610-567-3857