Provider Demographics
NPI:1477557999
Name:TORRES, IVETTE BERNADETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:BERNADETTE
Last Name:TORRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 GIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3117
Mailing Address - Country:US
Mailing Address - Phone:845-565-2810
Mailing Address - Fax:845-565-2879
Practice Address - Street 1:460 GIDNEY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3117
Practice Address - Country:US
Practice Address - Phone:845-565-2810
Practice Address - Fax:845-565-2879
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00800248Medicaid
C11494Medicare UPIN
NY59A851Medicare PIN