Provider Demographics
NPI:1174861900
Name:REYES-PASTORELLA, EVANGELINE TORRES
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:TORRES
Last Name:REYES-PASTORELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVANGELINE
Other - Middle Name:TORRES
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:3RD FL, CREDENTIALING MANAGER
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3906
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-909-9018
Practice Address - Fax:914-909-9028
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily