Provider Demographics
NPI:1093777609
Name:TORRES, MARINO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINO
Middle Name:
Last Name:TORRES
Suffix:
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 1:135 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1131
Mailing Address - Country:US
Mailing Address - Phone:212-923-5500
Mailing Address - Fax:212-740-2069
Practice Address - Street 1:135 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1131
Practice Address - Country:US
Practice Address - Phone:212-923-5500
Practice Address - Fax:212-740-2069
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2014782080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01601761Medicaid
NYG37452Medicare UPIN
NY537441Medicare ID - Type Unspecified