Provider Demographics
NPI:1144584723
Name:TORELLI, GRACE
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:TORELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MUNSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4409
Mailing Address - Country:US
Mailing Address - Phone:631-286-8634
Mailing Address - Fax:
Practice Address - Street 1:12 MUNSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4409
Practice Address - Country:US
Practice Address - Phone:631-286-8634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist