MEDICARE: DR. VERENISSE TORRES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	125.074383	IL
2	207Q00000X	Family Medicine Physician	318625	NY

General Provider Information

NPI Number	:	1386202216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERENISSE TORRES MD

Provider Business Mailing Address
First Line	:	PO BOX 1504
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10008-1504
Country	:	US
Telephone Number	:	917-310-3371
Fax Number	:

Provider Business Practice Location Address
First Line	:	8010 NORTHERN BLVD
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1345
Country	:	US
Telephone Number	:	917-310-3371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	09/08/2022

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