Provider Demographics
NPI:1568651933
Name:TOURO COLLEGE
Entity Type:Organization
Organization Name:TOURO COLLEGE
Other - Org Name:TOURO COLLEGE OF OSTEOPATHIC MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACADEMIC OFFICIER/DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-981-4510
Mailing Address - Street 1:230 W 125TH ST STE 327
Mailing Address - Street 2:TOUROCOM
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4402
Mailing Address - Country:US
Mailing Address - Phone:646-981-4500
Mailing Address - Fax:212-678-1785
Practice Address - Street 1:55 EAST 124TH STREET
Practice Address - Street 2:TOURO COLLEGE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1815
Practice Address - Country:US
Practice Address - Phone:212-410-8484
Practice Address - Fax:212-410-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220369207Q00000X
NY242970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH99020Medicare UPIN
MOD16535Medicare UPIN