Provider Demographics
NPI:1104861558
Name:LATORTUE, KARL E
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:E
Last Name:LATORTUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JASON CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5839
Mailing Address - Country:US
Mailing Address - Phone:631-827-9413
Mailing Address - Fax:
Practice Address - Street 1:350 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5137
Practice Address - Country:US
Practice Address - Phone:718-875-9500
Practice Address - Fax:718-875-7079
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199824173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG91304Medicare UPIN