Provider Demographics
NPI:1174508139
Name:TORRES OTERO, NORBERTO ISRAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NORBERTO
Middle Name:ISRAEL
Last Name:TORRES OTERO
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 1:12 GREENRIDGE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1238
Mailing Address - Country:US
Mailing Address - Phone:914-592-4312
Mailing Address - Fax:914-592-5305
Practice Address - Street 1:12 GREENRIDGE AVE STE 201
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1238
Practice Address - Country:US
Practice Address - Phone:914-592-4312
Practice Address - Fax:914-592-5305
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1837651OtherOXFORD HEALTH PLANS
NY01973019Medicaid
59N061OtherBLUE CROSS BLUE SHIELD
G94012Medicare UPIN
NY59N061Medicare ID - Type Unspecified