Provider Demographics
NPI:1023018058
Name:TORIELLO, EDWARD ALFRED JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALFRED
Last Name:TORIELLO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7815 ELIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1300
Mailing Address - Country:US
Mailing Address - Phone:718-458-8944
Mailing Address - Fax:718-458-6299
Practice Address - Street 1:7815 ELIOT AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1300
Practice Address - Country:US
Practice Address - Phone:718-458-8944
Practice Address - Fax:718-458-6299
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147994-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00885052Medicaid
02429GMedicare ID - Type UnspecifiedQUEENS
40D791Medicare ID - Type UnspecifiedBKLYN
NY00885052Medicaid