Provider Demographics
NPI:1518142694
Name:TORRICELLI, ITALO A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ITALO
Middle Name:A
Last Name:TORRICELLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 LUDLOW ST
Mailing Address - Street 2:SUITE 418
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1947
Mailing Address - Country:US
Mailing Address - Phone:914-968-4070
Mailing Address - Fax:914-968-5539
Practice Address - Street 1:45 LUDLOW ST
Practice Address - Street 2:SUITE 418
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1947
Practice Address - Country:US
Practice Address - Phone:914-968-4070
Practice Address - Fax:914-968-5539
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039528-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01180583Medicaid