Provider Demographics
NPI:1508820630
Name:TORNO, ROOSEVELT (MD)
Entity Type:Individual
Prefix:
First Name:ROOSEVELT
Middle Name:
Last Name:TORNO
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 1:339 HICKS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5514
Mailing Address - Country:US
Mailing Address - Phone:718-780-1005
Mailing Address - Fax:
Practice Address - Street 1:339 HICKS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5514
Practice Address - Country:US
Practice Address - Phone:718-780-1005
Practice Address - Fax:718-780-2740
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117153207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E04021Medicare UPIN
RT005F9610Medicare ID - Type Unspecified