Provider Demographics
NPI:1326155466
Name:TORRES, THERESA M
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:TORRES
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 1:20-20 FAIR LAWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410
Mailing Address - Country:US
Mailing Address - Phone:201-791-4545
Mailing Address - Fax:201-791-3709
Practice Address - Street 1:901 RT 23 SOUTH
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444
Practice Address - Country:US
Practice Address - Phone:973-831-4545
Practice Address - Fax:973-831-1527
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06325700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics